Proactive Care Lead, High Intensity Service Users

University Hospitals Coventry and Warwickshire; Coventry; On-site; GBP 42,000 - 60,000; Full time

Job summary

University Hospitals Coventry and Warwickshire NHS Trust is seeking a Proactive Care Lead to identify, coordinate and support high intensity service users across primary, community, acute, mental health and voluntary sectors. The role focuses on developing personalised care plans to promote self-management and reduce avoidable healthcare attendance.

The successful candidate will lead cross-disciplinary teams, uphold person-centred care, and contribute to service improvement across the system.

Qualifications

• Experience leading proactive care initiatives.
• Ability to coordinate across primary, community, acute, mental health and voluntary sector partners.
• Commitment to person-centred care.

Responsibilities

• Identify and coordinate high intensity service users across health and social care.
• Develop personalised care plans to reduce avoidable healthcare use.
• Collaborate with multidisciplinary teams to coordinate interventions.
• Maintain accurate records and contribute to service evaluation.

Skills

Leadership

Communication

Case management

Driving license

Job description

Secondment will be considered for internal candidates - If you are successful after interview, you must obtain approval from your current line manager to accept the offer. Successful applicants will be required to provide an immunisation and vaccination report, from either their current UK occupational health provider or their UK GP.

• Proactively identify and support high intensity service users who frequently access acute, community, primary care, urgent and emergency care services, ensuring their needs are assessed holistically and managed through coordinated care planned.
• Undertake comprehensive assessments of individuals with complex health, social, psychological, and behavioural needs to understand the factors contributing to high service utilisation and identify opportunities for alternative approaches to care.
• Develop, implement, and regularly review personalised care and support plans that promote self-management, improve health outcomes, and reduce avoidable healthcare attendance and admissions.
• Work collaboratively with multidisciplinary teams, including acute, community, primary care, mental health, social care, and voluntary sector services, to coordinate appropriate interventions and ensure seamless care delivery., Proactively identify and support high intensity service users who frequently access acute, community, primary care, urgent and emergency care services, ensuring their needs are assessed holistically and managed through coordinated care planning.
• Undertake comprehensive assessments of individuals with complex health, social, psychological, and behavioural needs to understand the factors contributing to high service utilisation and identify opportunities for alternative approaches to care.
• Develop, implement, and regularly review personalised care and support plans that promote self-management, improve health outcomes, and reduce avoidable healthcare attendance and admissions.
• Work collaboratively with multidisciplinary teams, including acute, community, primary care, mental health, social care, and voluntary sector services, to coordinate appropriate interventions and ensure seamless care delivery.
• Act as a key point of contact for high intensity service users, providing case management, advocacy, and support to navigate services and access the most appropriate care pathways.
• Identify patients who may benefit from receiving care in alternative settings, such as community services, primary care, outpatient clinics, or other specialist support services, ensuring care is delivered in the most appropriate and least restrictive environment.
• Monitor patterns of service utilisation and identify trends, risks, and opportunities for intervention to improve patient outcomes and reduce unnecessary demand on healthcare services.
• Support the development and implementation of strategies, pathways, and initiatives aimed at improving care for high intensity service users, reducing health inequalities, and promoting integrated care across organisational boundaries.
• Maintain accurate records, collect relevant data, and contribute to service evaluation, quality improvement, and reporting requirements to demonstrate outcomes and inform future service development.
• Build effective relationships with patients, carers, families, and partner organisations to promote person-centred, coordinated care that improves patient experience and quality of life. Are you passionate about improving outcomes for people with complex health and social care needs? We are seeking an experienced and motivated Proactive Care Lead to identify, coordinate and support high intensity service users who frequently access healthcare services. You will work collaboratively across primary care, community, acute, mental health and voluntary sector partners to develop personalised care plans, reduce health inequalities, and promote independence. The successful candidate will demonstrate strong leadership, excellent communication skills, and a commitment to delivering person-centred care. This is an exciting opportunity to drive innovation, improve patient experience, and support sustainable healthcare delivery across the system. A full UK driving license is essential for this post. Please note that an international driving license is not accepted. University Hospitals Coventry and Warwickshire NHS Trust, rated as good by the Care Quality Commission, is one of the largest teaching Trusts in the UK. We are extremely proud of our employees across our hospital sites, with high quality patient care at the heart of everything we do. Boasting some of the most modern facilities in Western Europe, the Trust is renowned for being at the forefront of research and innovation as part of its blossoming reputation as a worldwide leader in healthcare. We are proud to be recognised as a Pathway to Excellence® designated organisation - please click the link for further details about this prestigious award.Pathway To Excellence ® - University Hospitals Coventry & Warwickshire (uhcw.nhs.uk) By joining our exciting journey, you will form part of a passionate, talented team and will be able to access a wide range of learning and development opportunities. There has never been a better time to join our team. The Trust is committed to building an organisation that makes full use of the talents, skills, experience, and different perspectives available in our diverse society. We want everyone to feel they are respected, valued, can achieve their potential and receive the most appropriate and relevant care. We will create an environment where the equality and human rights principles of fairness, respect, equality, dignity and autonomy are promoted and are part of the organisation's core values.