Clinical Lead for Appeals and Retros

South West London Integrated Care Board; Wimbledon; On-site; GBP 64,000 - 71,000; Full time

Job summary

South West London Integrated Care Board is seeking an experienced clinical lead to head the All Age Continuing Care appeals and retrospective reviews team. You will oversee CHC eligibility appeals, ensure NICE/NHS England frameworks are followed, and represent the ICB at Independent Review Panels.

You will line manage the Appeals and Retros Clinical Manager, work with AACC and partner organisations, and drive service development while managing risks and budgets.

Qualifications

• Experience of clinical assessment and review of CHC patients.
• Experience of managing appeal and retrospective cases and IRP presentations.
• Experience coordinating projects in complex healthcare environments.

Responsibilities

• Lead the appeals and retrospective caseload and ensure standards are met.
• Represent SWL ICB AACC at Independent Review Panels and share learnings.
• Collaborate with partners to develop and improve services and line manage staff.

Education

Degree-level qualification in a relevant subject

Postgraduate qualification (relevant subject)

Registered healthcare professional (RN adult / OT / PT) with NMC/HCPC registration

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.

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.

Main duties of the job

• 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.
• 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.
• 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.
• Represent the service at multi-agency meetings and with NHS, local authority and other partner organisations.
• Lead on communication within the appeals and retrospective process, including decision letters, supporting documentation and correspondence, making sure it meets quality and assurance standards.
• Investigate complaints and provide outcomes, making sure the learning is shared with the AACC team and standard operating procedures are updated where needed.

About us

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.

The core responsibilities of an ICB are to:

Improve outcomes in population health and healthcare.

Tackle inequalities in outcomes, experience and access.

Enhance productivity and value for money; and

Support broader social and economic development in their area

The ICB provides system leadership for population health, setting the evidence base and long-term population health strategy. We work as healthcare payers to deliver this, maximising the value that can be created from the available resources. This involves investing in, purchasing and evaluating the range of services and pathways required to ensure access to high quality care, in order to improve outcomes and reduce inequalities within South West London.

Job responsibilities

Please see the attached job description and person specification for full details of the duties and responsibilities of the role.

Person Specification

Qualifications

• Educated to degree level in a relevant subject, or equivalent qualification or significant experience at a similar level in a specialist area
• Postgraduate degree in a relevant subject, and evidence of continued professional development
• Qualified healthcare professional (RN (adult), OT or PT) with current and relevant registration with the NMC or HCPC

Experience

• Experience of clinical assessment and review of CHC patients, managing appeal and retrospective cases, and presenting at Independent Review Panels (IRP) with NHS England
• Demonstrable experience of coordinating projects in complex and challenging healthcare environments, with comprehensive knowledge of project principles, techniques and tools (e.g. PRINCE2)
• Significant experience of successfully operating in a politically sensitive environment
• Experience of managing risks and reporting, and of drafting briefing papers and correspondence for a senior audience
• Experience of monitoring budgets and business planning processes; numerate and able to understand complex financial issues, including financial risk
• Experience of setting up and implementing internal processes and procedures

Knowledge

• Excellent knowledge of AACC national and local policy, and good knowledge of all aspects of AACC (Clinical, Brokerage, Contracting, Finance, Business Intelligence and Quality)

Skills and ability

• Able to provide and receive highly complex, sensitive or contentious information, negotiate with senior stakeholders, clients and their representatives, and present to large and influential groups
• Ability to analyse highly complex, conflicting information drawn from multiple sources, and to take decisions autonomously on difficult and contentious issues where there are several courses of action
• Strategic thinker who can anticipate and resolve problems, plan over short, medium and long-term timeframes and adjust plans and resources to tight and changing timescales

Leadership

• Experience of managing and motivating a team, directing the work of others and reviewing individual performance, with strong compassionate and inclusive leadership

Values and behaviours

• Demonstrates commitment to NHS and organisational values, role-models behaviours that support equality, diversity, belonging and inclusion, and works flexibly as part of a team

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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