Care Navigator in Nottingham

Are you passionate about patient care and want to make a difference to patients by navigating them through health & social systems? We are seeking to recruit 1 WTE Care Navigator for Bassetlaw. The role of Care Navigator is new to Bassetlaw; it's a great opportunity for someone who is enthusiastic & passionate about patient care. You will work collaboratively with primary care, community services, secondary care, social care and the voluntary sector (as appropriate and based on patient need). This will improve outcomes for patients and reduce healthcare costs. The focus of the role is to identify and manage vulnerable patients (initially those with moderate and severe frailty and subsequently those living with long term conditions). This is fundamental to the delivery of the Integrated Care System (ICS) Frailty program. It is also fully aligned with the delivery of the ICS Integrated Care Strategy and NHS Joint Forward Plan addressing the specific needs of an ageing population and recognizing the economic and quality of life impacts of prioritising frailty management.

Main duties of the job

• Undertake daily identification of frailty and long-term condition workflows on E-Healthscope and decide the best course of action based on agreed Standard Operating Procedures (SOPs) and advice from clinicians/other key leads.
• Proactively contact patients to complete the CFS and provide advice and refer to teams/services/local assets (where appropriate).
• Undertake a holistic assessment/goal setting to ensure an advanced care plan is in place and agreed e.g. All About Me.
• Provide information to members of the PCN to aid communication.
• Complete relevant referral documentation and chase referrals as required and navigate and coordinate services to meet individuals' needs across the PCN.
• Access systems utilised across the ICS to support case analysis this includes but not limited to, Social Care, Mental Health and General Practice.
• Work closely with the integrated neighbourhood team for access to community-based activities.

About us

We are a provider of NHS Community Health Services, CityCare exists to support the health and wellbeing of all local people, working alongside other health and care partners to achieve this. We are a value driven, people business with a passion for excellence. Our vision and social purpose is to make a difference every day to the health & wellbeing of our communities and our values of kindness, respect, trust and honesty lie at the heart of everything we do, guiding how we work together with partners and each other to consistently deliver high quality compassionate care. As a social enterprise we aim to add social value by investing in the future of our local communities and helping to make a difference in people's lives. CityCare values the benefits of a diverse and inclusive workforce. We encourage applications from candidates who identify as disabled, LGBT+ or from a Black, Asian or Minority Ethnic (BAME) background, as they are currently under-represented within our organisation. We are proud to be a forces-friendly organisation and are dedicated to supporting Veterans, Service Leavers, Reservists, and military spouses/partners. We value the unique skills and contributions you bring. CityCare is an equal opportunities employer. We are positive about employing people with disabilities.

Job responsibilities

Job Purpose

To focus on the identification and management of vulnerable patients (initially those with moderate and severe frailty and subsequently those living with long term conditions). This refocus is fundamental to the delivery of the Integrated Care System (ICS) Frailty Programme. To work in alignment with the delivery of the ICS Integrated Care Strategy and NHS Joint Forward Plan addressing the specific needs of an ageing population and recognizing the economic and quality of life impacts of prioritising frailty management.

Key Responsibilities

• Undertake daily identification of frailty and long-term condition workflows on E-Healthscope and decide the best course of action based on agreed Standard Operating Procedures (SOPs) and advice from clinicians/other key leads.
• Proactively contact patients to complete the CFS and provide advice and refer to teams/services/local assets (where appropriate).
• Undertake a holistic assessment/goal setting to ensure an advanced care plan is in place and agreed e.g. All About Me.
• Provide information to members of the PCN to aid communication.
• Complete relevant referral documentation and chase referrals as required and navigate and coordinate services to meet individuals' needs across the PCN.
• Access systems utilised across the ICS to support case analysis this includes but not limited to, Social Care, Mental Health and General Practice.
• Work closely with the integrated neighbourhood team for access to community-based activities.

Data management

To contribute to the integration of health and social care by maintaining up to date recording systems for all agencies within the team and providing information to any member of the neighbourhood team to ease processes and communication in agreement with data protection protocol. To be responsible for recording, reporting and producing evaluation reports which will include evaluation detailing effectiveness outcomes of new roles. To receive, breakdown and co‑ordinate data and produce spreadsheets for analysis (which shall include identification of referral trends and geographical spread of referrals and interventions to support the delivery of care within the PCN). Support and undertake service monitoring, evaluation and documenting outcomes to ensure consistent delivery of high quality, effective and cost‑effective services.

Person Specification

Qualifications

• Excellent working knowledge of Microsoft Office software.
• A-level / NVQ 3 or equivalent experience in admin / business / marketing / customer service environment.
• Working knowledge of Excel and the management of databases.

Additional Criteria

• Ability to be flexible over hours worked within contracted hours to meet the needs of the service.
• Ability to work out of hours.
• Full driving licence and the ability to travel between locations.
• To participate in and fulfil the requirements of the Directors on-call arrangements.

Experience

• Experience of office procedures working at a high level as part of an administration team / within an administration role.
• Experience of dealing with sensitive/confidential information.
• Experience of working within Multidisciplinary teams.

Skills & Attributes

• Experience of working in Customer Care.
• Assertiveness, ability to self‑motivate and motivate others.
• Understanding and able to deal with confidential and sensitive issues when liaising with team members / other professionals.
• Ability to prioritise, organise and delegate workload to meet deadlines.
• Excellent communication and listening skills.
• Awareness of the barriers to effective communication.
• Understanding of and commitment to equal opportunities and equity in service delivery.
• Ability to work under pressure with constant interruptions requiring skills in multi‑tasking, always maintaining accuracy.
• Ability to problem-solve and support others in resolving problems.
• Ability to manage conflicting issues assertively and sensitively.
• Remain calm under pressure.
• Ability to plan and organise own and team's workload.
• Be flexible in the management / involvement of development and change.
• Knowledge and understanding of relevant health and social care legislation and initiatives.
• Experience of supervising and training others on admin processes and procedures.

Disclosure and Barring Service Check

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.