Main duties and responsibilities:
Caseload identification and management; become a contact point within the practice for patients who are:
1. Complex and/or frail
2. Frequent attenders for GP appointments
3. Recently discharged from hospital
4. Requiring active signposting to support services
5. New patients on list with specific needs
Signposting and care navigation; first point of contact for patients, clinicians, and community carers in delivering personalised care to patients following up referrals, resolving information requests. Referring to appropriate services e.g. social prescriber, wheelchair services, continence team, hospices etc.
Data analysis, auditing, coding, reporting, and sharing information. Ensuring data in each record is correct and up-to-date, and ensuring coding is accurate. Using this information to create reports and share information with other services. Support the coordination and delivery of MDT meetings. Provide coordination and navigation with the aid of digital tools for people and their carers across health and care services.
Person Specification
Knowledge and skills
Essential
1. Understanding of human needs physical, emotional, social
2. Proven ability to recognise and manage risk
3. Knowledge of the needs of vulnerable adults, safeguarding and the associated legislative framework
4. Understanding of basic health and social care terminology
5. Good interpersonal skills
6. Ability to communicate confidently with staff of all seniority levels
7. Ability to work well across teams
8. Good time management and prioritisation skills, ability to work to strict deadlines
9. Ability to work on own initiative without direct supervision, understanding where clinical input is needed
10. Understanding of when appropriate or necessary to refer people back to other health professionals/agencies
11. IT skills and experience in the use of Microsoft Excel
Desirable
1. Familiarity with IT systems currently in use in health and social care settings
2. Use of DOCMAN or similar software
3. Awareness of local referral pathways
4. Experience of working directly in a community development context, adult health and social care, learning support or public health/health improvement (including unpaid work)
5. Experience of supporting people with their mental health
6. Experience of collaborative working and building relationships across varied organisations
Experience
Essential
1. Experience of working with healthcare professionals and or previous experience in the NHS or social care or relevant field (including unpaid work)
2. Experience of administrative work
3. Experience of working with data
Desirable
1. Experience of supporting people, their families and carers in a related role (including unpaid work)
2. Experience of working with or in general practice
Qualifications
Essential
1. Valid driving licence/ vehicle with business insurance
2. Demonstrable commitment to professional and personal development
3. 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.
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