A Senior Care Coordinator is responsible for managing and overseeing patient care to ensure they receive the appropriate treatments, services, and support in a timely manner. The Care Coordinator plays a critical role in facilitating and managing the care of patients through the healthcare system. This includes assisting patients with navigating medical services, coordinating with healthcare providers, and ensuring that patients receive timely, efficient, and cost-effective care.
This is a really exciting and pivotal role within the wider multidisciplinary team at Hope Farm Medical Centre and if you're empathetic, patient-centered and want to make a real difference to patients' experience in navigating the health system this role is for you.
Main duties of the job
Care coordinators help to coordinate and navigate care across the health and care system, helping people make the right connections, with the right teams at the right time. They can support people to become more active in their own health and care and are skilled in assessing people's changing needs. Care coordinators are effective in bringing together multidisciplinary teams to support people's complex health and care needs.
Care coordinators work with people to build trusting relationships and listen to what matters to them. They work with a range of people, particularly those with long-term conditions, multiple long-term conditions, and people living with or at risk of frailty. They help people coordinate and navigate their care across the health and care system and can support people to become more active in their own health and care.
About us
With an appetite for innovation and creativity, underpinned by a strong belief in traditional primary care values, Hope Farm Medical Centre nurtures a culture which is modern, vibrant, forward-thinking, and caring. Enabling people to access a medical practice that is at the heart of the community where each and every patient matters.
Values
* Trustworthy - be transparent with patients and colleagues, the little things do matter
* Vulnerable - educate and communicate, embrace change and innovation openly
* Empathetic - understanding others, champion equality & diversity, celebrate differences and inclusivity
* Resilient - have excellence in everything we do as a team and individuals, and do so with humility and humour
Job responsibilities
Key responsibilities
* To act as the main conduit between the medical centre and the aligned care homes under the Enhanced Health in Care Homes local enhanced service.
* Be responsible for the daily management and communication with aligned care homes including dealing with queries such as urgent requests for care and routine reviews through appropriate triage.
* Be responsible for coordinating the care home ward rounds in line with the direct enhanced service.
* Be responsible for the provision of cover for the Care Home Nurse Associate to ensure continuation of medication queries, new patient reviews via home visit to complete support plans, do not attempt resuscitation discussions, advanced care planning discussions and coding on medical records in conjunction with other healthcare professionals.
* Be responsible for the completion of all new registrations for care home aligned patients including summarising patients records if no GP2GP received, including externally sourcing all relevant medical records through the appropriate channels.
* Be responsible for all external care home related duties including but not limited to liaising with all services, appropriate referrals for further care, chasing outstanding clinical information such as external assessments and results.
* Be responsible as the direct point of contact for next of kin in relation to all queries, offering support and appropriate signposting where appropriate.
* Be responsible for the coordination of care home vaccinations, QOF objectives and all DES/LES requirements to be met in line with the enhanced services.
Community Services
* To be the main conduit between community teams and the medical centre.
* To be responsible for effective and timely communication with the wider multi-disciplinary teams including clinical district nurses, specialist palliative nurses, continence teams, respiratory services, occupational therapists and physiotherapy leads. Supporting all queries, referrals and collaborative working between the medical centre and community teams.
Palliative Care
* To be the direct point of contact for palliative care patients following transfer to the Care Coordinator from the general practitioner alongside reviewing palliative care registry.
* To provide support for patients and next of kin included but not limited to emotionally and psychologically alongside supporting with the appropriate clinical reviews and offering continuity of care.
* Where appropriate provide additional support by visiting families to support with social dynamics, supporting with medication ordering (repeats and acutes) alongside supporting families with the appropriate social support, including referrals into adult social care for package of care assessments where appropriate.
* Ensure Electronic Palliative Care Coordination Systems (EPaCCS) are updated and patients', next of kin or legal advocates wishes are discussed and correctly documented alongside referring into the community care team for palliative support and/or referring to specialist care services where appropriate.
Medical Examiner
* Be responsible as the direct point of contact with the medical examiner for medical certificate referrals and to resolve queries alongside the appropriate referring GP.
* Be responsible as the direct point of contact with the coroner to support GPs including referrals and supporting with queries where needed.
* To be responsible for the provision of bereavement support internally for expected and at times unexpected deaths in the community including discussions with all next of kin/legal advocates such as lasting power of attorney and/or deputyships and to provide clarity on next steps in relation to medical examiner and/or coroner involvement where appropriate.
Safeguarding
* Be responsible for all safeguarding queries received through the safeguarding account including actioning police reports, social worker report requests (including but not limited to initial assessments, team around the family reports, 360-reports alongside completion of safeguarding conference reports) for review by the patients' usual general practitioner.
* Be responsible for preparing safeguarding reports for the family court for review by the patients' usual general practitioner.
* Be responsible for all ad-hoc communication with social workers contacting the medical centre seeking supporting information to new referrals or known service users.
Multidisciplinary Teams
* Be accountable for the multidisciplinary team monthly meetings including scheduling invites and selecting appropriate patients for discussion prior to the meeting within a timely manner, proactively communicating the list of patients to be discussed at the meeting with internal and external clinicians.
* Be accountable for chairing the MDT meetings, taking minutes from the meeting and ensuring all actions are recorded, logged and circulated to MDT attendees and actioned accordingly.
* Be accountable for coordinating the patient participation group at the medical centre.
* Be responsible for dealing with PPG member queries and supporting recruitment of new members.
* Be accountable for arranging the PPG meetings, developing the agenda alongside members, taking minutes and logging actions alongside relevant PPG members.
Management
* Be responsible for the management of other Care Coordinators.
* Be responsible for providing mentoring and day-to-day support/direction to the other Care Coordinators.
* Be responsible for ensuring Care Coordinator tasks and duties are covered across the team during annual leave and other periods of absence.
* Be responsible for the completion of Care Coordinator annual appraisals and wellbeing/welfare checks.
Other responsibilities
* To be the point of internal contact for discussions, clinical and social, for complex patients and care planning and advice.
* To offer support for colleagues including appropriate education and signposting of services internally and externally where applicable.
Person Specification
Qualifications
* NVQ Level 3 Business Administration - or equivalent.
* GCSE Math and English Grade C or above - or equivalent.
Skills and Competencies
* Strong communication and interpersonal skills.
* Excellent organisational and time-management abilities.
* Evidence of effective use of Microsoft Office products.
* Knowledge of healthcare systems, patient care procedures, and medical terminology.
* Ability to work independently and as part of a team, whilst managing and prioritising workload.
* Problem-solving and decision-making skills, with strong analytical and judgment skills.
* Proficiency in using electronic health records (EHR) systems and other healthcare software - training will be provided.
* Able to demonstrate a clear understanding of working with confidential information and an understanding of service user confidentiality.
* Knowledge/Familiarity with medical terminology.
Key attributes
* Compassionate and empathetic.
* Strong attention to detail.
* Patient and family-focused with a commitment to improving patient outcomes.
* Ability to handle stressful situations with calmness and professionalism.
* Requires a flexible approach and a highly motivated post-holder.
Experience
* Experience in case management, care coordination, or patient services is beneficial.
* Previous experience in a healthcare setting, such as a general practice, hospital, clinic, is preferred.
* Vulnerable adult awareness and experience of care of the elderly.
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.
£30,000 to £33,000 a year plus NHS pension.
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