Clinical Lead for Appeals and Retros

South West London Integrated Care Board; Greater London; On-site; GBP 70,000 - 90,000; Full time

Job summary

NHS South West London ICB is seeking an experienced Clinical Lead for Appeals and Retros to head the All Age Continuing Care appeals team. You will oversee the central unit responsible for CHC and NHS-funded Nursing Care eligibility appeals and retrospective reviews, ensuring clear communication with clients and representatives and adherence to the National Framework.

In addition to leading the team, you will represent SWL ICB at NHS England Independent Review Panels, share learning across AACC

Qualifications

• Registered nurse (adult), occupational therapist or physiotherapist with a postgraduate qualification.

Responsibilities

• Manage the appeals and retrospective caseload to meet local, regional and national standards.
• Represent SWL ICB AACC at Independent Review Panels hosted by NHS England.
• Collate NHS England feedback from Independent Review Panels and share learning with the wider AACC team.
• Represent the service at multi-agency meetings with NHS, local authorities and partner organisations.
• Lead on communication within the appeals process, ensuring decision letters and documentation meet quality standards.
• Investigate complaints and provide outcomes, updating SOPs with lessons learned.

Skills

Team leadership

Risk management

Budget management

Independent Review Panels

Education

Postgraduate qualification

Job description

NHS South West London ICB is looking for an experienced, registered healthcare professional to lead our All Age Continuing Care (AACC) appeals and retrospective reviews team as Clinical Lead for Appeals and Retros.
You will be responsible for the central team that manages and delivers appeals and retrospective reviews of people's eligibility for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care. You will make sure there are clear communication pathways with clients and their representatives, that the National Framework for CHC was followed at the outset, and that the appeals process is followed through each of its stages.
You will lead on representing the ICB at NHS England Independent Review Panels and make sure the learning from them is shared with AACC teams across the ICB. Working closely with the AACC service, local authorities and other partners, you will help develop, analyse and improve the service, and you will line manage the Appeals and Retros Clinical Manager.,

• o Manage the appeals and retrospective caseload where a CHC eligibility decision is being appealed or a retrospective assessment is requested for a period of unassessed care, making sure the service meets local, regional and national standards.
• o Lead on representing SWL ICB AACC at Independent Review Panels hosted by NHS England, presenting cases with empathy and professionalism and offering assurance and apology where needed.
• o Collate NHS England feedback from Independent Review Panels and share the learning with the wider AACC team to embed good practice and improve ways of working.
• o Represent the service at multi-agency meetings and with NHS, local authority and other partner organisations.
• o Lead on communication within the appeals and retrospective process, including decision letters, supporting documentation and correspondence, making sure it meets quality and assurance standards.
• o Investigate complaints and provide outcomes, making sure the learning is shared with the AACC team
  and standard operating procedures are updated where needed.

You will be a registered nurse (adult), occupational therapist or physiotherapist with a postgraduate qualification, an excellent knowledge of the National Framework, and experience of managing appeal and retrospective cases and presenting at Independent Review Panels. You will also have experience of leading a team, working in politically sensitive settings, and managing risk and budgets.

The core purpose of SWL ICB is to improve the health of our population and ensure access to consistently high-quality services. Overseeing a budget of £4.3bn we hold accountability for ensuring the best use of the health budget for SW London's population in order to improve health and healthcare, both now and in the future.