Proactive Care Coordinator

We are seeking two Proactive Care Coordinators to join our Health and Social care system within St. Helen’s, within Contact Cares. This is an exciting opportunity for a committed and reliable person to take on a challenging and sometimes pressured role. Applicants must possess excellent communication and organisational skills, be able to communicate effectively with people at a senior level and have the ability to time‑manage and work well as part of a team.

Main duties of the job:

• Proactive Care Coordinator’s role is pivotal to effective delivery of care and serves as the interface between patients, service users, carers, primary, secondary and community/social care, and voluntary organisations.
• Post holders work flexibly across a range of services within the St. Helen’s Borough and neighbourhood localities, planning, organising, coordinating and feeding back in Team Meetings.
• The post holder may be required to work some flexible hours.

Key duties include:

• Completion of duty screening calls and referrals following referrals received by GP/professional.
• Independent completion of assessments in patient homes, often vulnerable/home‑less or self‑neglect patients/service users, recording a baseline of clinical observations (Blood Pressure, Oxygen Saturations, Temperature, Blood Glucose).
• Utilise knowledge of pressure sore prevention and prescribed pressure‑relieving equipment/products.
• Implement and evaluate a plan of care for simple wound management, as directed by a registered practitioner.
• Venepuncture and other clinical skills to enhance the delivery of patient care.
• Identify and use opportunities to promote healthy lifestyles.
• Maintain up‑to‑date knowledge of local services available to patients.
• Act as advocate and facilitator to resolve issues that may be perceived as barriers to care.
• Support people in accessing appropriate information and support, by sign‑posting to a range of support services and encouraging self‑management where appropriate.
• Make pre‑planned outbound telephone calls to patients to assess ongoing needs.
• Maintain accurate, clear and contemporaneous records as per Trust policy and communicate information to Team members as necessary.
• Liaise with referrers, patients, relatives, carers and other health and social care professionals to support and coordinate care.
• Act as a contact for case management of patients at risk of admission, identifying sources of support in liaison with case managers.
• Attend the Hospitals Frequent Attenders MDT Meeting and link with GP practices to reduce A&E admissions.
• Promote and inform GP’s, District Nurses and Contact Cares of other services and initiatives available to support patients and prevent hospital admissions/readmissions.

Administrative responsibilities:

• Independently manage and prioritise own workload on a daily basis, within parameters of role.
• Coordinate and manage the administrative functions for the integrated Multi‑disciplinary Team Meetings, including organising and adjusting meetings and tasks on behalf of multiple stakeholders.
• Serve as point of liaison for service users receiving care coordination and interface with all professionals involved in service users care.
• Receive telephone calls and correspondence from partnership health professionals, triaging calls based on service criteria and guidance from professionals.
• Co‑ordinate handover between Acute and Community providers to facilitate safe and effective transition of care.
• Take responsibility for facilitation of regular Multidisciplinary Team Meetings and collate information from a range of strategies/projects.
• Develop and maintain efficient filing, clerical and office systems, including photocopying, faxing and handling other forms as required.
• Establish and maintain a frailty register.
• Contribute to implementation of standard operating procedures and processes for administrative and clinical systems.

Information technology responsibilities:

• Proficient in using Microsoft Office packages and other identified IT systems.
• Support MDT and CCG Commissioners in developing risk‑profiling strategies and tools.
• Extract relevant patient information from various IT systems and communicate into MDTs.
• Update service records contemporaneously on relevant IT systems following MDT Meetings.
• Support completion of patient/service user referrals, record electronically and feedback to team members.
• Maintain Excel database for collection and analysis of complex data relating to MDT performance measurements.
• Compile and send monthly statistical reports.
• Conduct research and audit activities, extracting caseload information and supporting audit processes.

Teaching & Training responsibilities:

• Demonstrate self‑directed learning and seek role development opportunities.
• Utilise informal and formal learning opportunities independently and with others.
• Participate in annual performance review and pursue continuous professional development.
• Identify personal education needs and skills development with line manager.
• Maintain a personal development plan and competency portfolio.
• Support training requirements of clinicians to access and use data systems, coaching individuals where necessary.
• Contribute to education of student nurses/therapists and health care assistants as required.

Person specification – Qualifications:

• NVQ3 or recognised certificate in Health or Social Care or equivalent qualification/experience.
• Evidence of continued role development.

Knowledge & Experience:

• Extensive experience working within Health and/or Social Care.
• Demonstrate IT literacy across a range of IT and administrative systems / data management.
• Evidence of ability to communicate at all levels across all boundaries.
• Experience of supporting Service Improvement.
• Experience of working within a multi‑disciplinary setting.
• Evidence of dealing with people in highly emotive situations.
• Ability to provide confidential administrative support within a complex service.
• Demonstrate a substantial theoretical and practical knowledge of Health & Social Care agenda’s, policies, processes and pathways.

Skills:

• Ability to provide & receive complex information, motivate & negotiate.
• Work independently and as part of a team.
• Prioritise own workload between competing demands.
• Develop effective working relationships with all stakeholders.
• Flexibility to meet the demands of the service.
• Proactive approach with own initiative.
• Demonstrate autonomy and accountability in duties.
• Understand own limitations.
• Committed to developing self and others.
• Provide constructive opinions and ideas for service improvement.
• Work as part of a wider team, providing flexible working across localities.
• Competencies achieved within the workplace and attendance at a Higher Education Institute (HEI) as part of the assistant practitioner (AP) or Nurse Associate (NA) programme.

Other:

• Demonstrate a commitment to respecting and displaying the Trust Values at all times.
• Ability to travel to various hospital, clinic and domiciliary locations by own car/assisted driver.

Equality, Diversity and Inclusion:

We actively cultivate a professional environment of fairness, equality, dignity, and respect for all individuals. We welcome individuals from all backgrounds and value the unique skills, perspectives and experiences you bring. We are grounded in the belief that diversity enhances our collective strength, fostering innovation and excellence within our workforce. We welcome all applications irrespective of race, disability, gender, sexual orientation, religion/belief, age, gender identity, marriage and civil partnership, pregnancy/maternity, and especially those from under‑represented groups. As a Disability Confident Leader, we commit to offering an interview to all disabled applicants who meet the minimum criteria for the job. We also commit to offering an interview to all armed forces veterans who meet the minimum criteria for the job.