An excellent opportunity has arisen for a Care Coordinator to join our Primary Care Network. A Care Coordinator works with patients, devising and organising personalised care plans, enabling patients to access health, social care and wellbeing services, professionals and information tailored to their individual needs.
Main duties of the job
The Care Coordinator holds a case-load of patients, guiding each patient through the various pathways and processes, facilitating actions and liaising as required.
The Care Coordinator is a key part of the PCN Primary Care Team, working in tandem with the GPs, the nursing, administrative/reception and pharmacy teams and linking with partner services such as the Integrated Care Team and Physiotherapists.
Job responsibilities
* Working with the primary care team, identify cohorts of patients for whom personalised care plans would be beneficial.
* Contact and work with these patients to develop agreed, tailored care and support plans.
* Check and ensure each patient understands and considers the options and choices available to them for each element of their care plan.
* Source and provide patients with relevant and appropriate information to support shared decision making.
* Collate the agreed care and support needs into a personalised care plan in line with best practice and upload and regularly update the plan on the patient record.
* Assist the patient to navigate and progress through the relevant pathways, processes and systems; answering patient questions, making phone-calls, appointments, arrangements for care, liaising with professionals, service personnel and wider stakeholders.
* Work with the multidisciplinary practice team to design and implement new pathways for effective follow-up of patients with Long Term Conditions.
* Implement a process for safety-netting at the practice, so patients are followed up effectively.
* Assist the patient to access self-education, personalised budgets advice, employment advice, befriending and community activities support and resources to meet their wellbeing needs.
* Liaise with health and social care professionals to progress plans and follow-up on any identified barriers, taking action to resolve them.
* Work in a safe and organised manner.
* Work with the other PCN Care Coordinators to share learning and best practice.
* Provide cross-cover for the other care coordinators within the PCN Team at times of annual leave and sickness.
* Work with and assist our secretaries with cases which require coordination.
* Build and maintain effective relationships with members of the Primary Care Teams, The PCN community services, Social Prescribing and Wellbeing Coaches, ICS Coordinator.
* Participate in MDT meetings, Practice and PCN Meetings.
* Observe and comply with appropriate statutory requirements in relation to Child and Adult Safeguarding.
* Undertake mandatory training.
* Comply with Data Protection and Information Governance regulations and policies.
Person Specification
Qualifications
* Good level of education to GCSE standard or equivalent.
Experience
* Experience of working in a patient facing role in primary care or health care setting.
* Competent in the use of Microsoft Office and/or clinical systems.
* Experience of working to set procedures/protocols and quality standards.
Personal Attributes
* Keen to learn new skills.
* Have a can do attitude and be able to demonstrate a flexible approach to the working day.
* Have a professional manner - well presented, personable, polite and patient.
* Hold Full UK driving licence and have regular access to a vehicle.
Skills and Abilities
* Ability to organise own tasks and work systematically.
* Excellent communicator both verbally and written demonstrated with people at all levels and in all circumstances.
* Capable of working with consistent accuracy and concentration in a busy environment.
* Ability to work under pressure and meet deadlines.
* Able to work both independently without supervision and within a team.
* Flexible in approach to work and ability to cover colleagues during leave/busy periods.
Knowledge and Understanding
* Demonstrate an understanding and commitment to good standards of patient care.
* Understands the role of GP services / Primary Care role within NHS System.
* Understanding of and commitment to Health & Safety in the workplace.
* Good understanding of confidentiality and working within information governance requirements.
* Knowledge of clinical system software e.g. EMIS and/or System One.
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