Appeals and Retros Clinical Manager

NHS South West London ICB is looking for an experienced, registered health professional to join our All Age Continuing Care (AACC) service as Appeals and Retros Clinical Manager. Working alongside the Clinical Lead for Appeals and Retros, you will case manage appeals and retrospective assessments for the AACC service across south west London. You will liaise with clients, their families and representatives, and other key people, to ensure the National Framework for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care was applied correctly at the outset and that the appeals process is followed through each of its stages.

Where appropriate, you will represent the ICB at NHS England Independent Review Panels and ensure the learning from them is shared with AACC teams across the ICB. You will also deputise for the Clinical Lead, support the development of staff in the team, and help shape how the service develops. You will bring strong CHC clinical assessment experience, an excellent working knowledge of the National Framework, and the ability to analyse complex and conflicting evidence and turn it into clear, well-reasoned recommendations. Experience of managing appeal and retrospective cases and presenting at Independent Review Panels would be an advantage.

Main duties of the job:

• Triage all appeal and retrospective review referrals, liaising with applicants to ensure each referral holds enough information to trigger a full appeal or retrospective review.
• Manage a delegated caseload of CHC appeal and retrospective review cases, scrutinising clinical records, care plans, Decision Support Tools and MDT evidence against the National Framework, and prioritising work so that statutory and internal timescales are met.
• Write clear, evidence-based rationales, appeal summaries, case reviews and eligibility recommendations for Local Resolution Meetings, Independent Review Panels and internal governance panels.
• Represent SWL ICB AACC at Independent Review Panels hosted by NHS England, presenting cases with empathy and professionalism and offering assurance and apology where needed.
• Communicate sensitive and complex information, including diagnosis, prognosis and life-changing decisions, to clients, families, staff, NHS England and partner organisations.

About us:

On 1 July 2022, NHS South West London Integrated Care Board (ICB) was established. The ICB, as part of South West London Integrated Care System (ICS), is a partnership of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in our six boroughs: Croydon, Merton, Kingston, Richmond, Sutton and Wandsworth.

Each ICS consists of two statutory elements: an Integrated Care Board, bringing the NHS together with its partners locally to improve health and care services and an Integrated Care Partnership (ICP): the broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by the ICB and local authorities in the area.

ICBs are statutory NHS bodies responsible for planning and allocating resources to meet the four core purposes of integrated care systems (ICSs): to improve outcomes in population health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money and; help the NHS support broader social and economic development.

NHS South West London Integrated Care Board decides how the South West London NHS budget is spent and develops plans to improve people's health, deliver higher quality care, and better value for money.

Job responsibilities:

• Quality assure Decision Support Tools, checklists and appeal documentation, and develop and monitor clinical standards, audit and peer review for the service.
• Act as an advocate for vulnerable people, challenging poor practice and discriminatory behaviour and escalating safeguarding and clinical concerns promptly.
• Track the financial risk linked to appeal and retrospective cases, and ensure any financial restitution is carried out promptly and in line with Standing Financial Instructions.
• Deputise for the Clinical Lead, support the allocation of the team's workload against KPIs, and contribute to staff recruitment, induction, appraisal, training and development.
• Support complaint investigations, policy and procedure development, training for health and care providers, and the sharing of best practice across the service.

Person Specification:

Qualifications:

• Essential: Registered health professional with current professional registration (e.g. NMC, HCPC)
• Degree or equivalent level of experience in health or social care
• Advanced clinical assessment skills
• Desirable: Management qualification

Experience:

• Essential: Experience of operational service management, change management and service improvement, including leading successful projects
• Desirable: Experience of managing appeal and retrospective cases, and presenting at Independent Review Panels (IRP) with NHS England

Knowledge:

• Essential: Excellent knowledge of AACC national and local policy, including the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, and working knowledge of all aspects of AACC (Clinical, Brokerage, Contracting, Finance, Business Intelligence and Quality)
• Desirable: Knowledge of service performance management and driving performance using complex data

Skills and ability:

• Essential: Ability to analyse very complex, conflicting information drawn from multiple sources, and to write comprehensive reports that can be understood by health and social care professionals and lay people
• Ability to communicate sensitive and complex decisions to clients, families, professionals and other stakeholders, and to manage conflict and challenging behaviour with tact, diplomacy and empathy
• Able to make evidence-based decisions on incomplete information, and to plan and manage own workload over short, medium and long-term timeframes to tight and changing deadlines
• Experience of setting up and implementing internal processes and procedures

Leadership:

• Essential: Acts as a leader while being a good team player; able to challenge and support others appropriately and to promote equality of opportunity and good working relations

Values and behaviours:

• Essential: Demonstrates commitment to NHS and organisational values, and role-models compassionate, inclusive leadership that supports equality, diversity, belonging and inclusion

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.