Job summary
The post holder will have a lead role with respect to NHS Continuing Healthcare (CHC) appeals and retrospective reviews. ,
The role requires the clinician to review and collate large amounts of evidence (including medical, health and care records), coordination of meetings with families/solicitors and the completion of eligibility reviews that includes outcome letters/reports. Required to attend Local Resolution and Multi-disciplinary Team meetings, engage with applicants and participate in deliberations concerning CHC eligibility.
Main duties of the job
Provide clinical expertise for CHC appeals, and retrospective reviews
Ensure that processed outlined within the National Framework process has been robustly applied within the Appeal, retrospective review and dispute process, with evidence to support CHC eligibility recommendations and decision making
Co-ordinate and Chair both local resolution and retrospective review meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility
Meet with patients/representatives in potentially highly contentious situations and provide responses to complex CHC-related challenges. This can include via telephone, via video call or in person (as required)
Be expected to engage with patients and public in a meaningful way in relation to CHC appeals and retrospective reviews (including leading on the stage 1 clinical call process)
Ensure patient/families/representatives are supported and aware of the appeal and retrospective review processes followed by the ICB in relation to CHC
Complete detailed, accurate and efficient reviews of all evidence sourced
Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments
About us
- Adhere to and uphold the ICB's vision and values.
- Observe the provisions of and adhere to all ICB policies and procedures.
- Complete ICB Statutory and Mandatory training as required and any other training courses relevant to the post.
- Abide by the ICB's commitment that all staff will be treated with respect by management, colleagues, patients and visitors and equally staff will treat management, colleagues, patients and visitors with the same level of respect. Staff will be supported to challenge any discriminatory behaviour that may be based on differences in race, disability, language, culture, religion, sexuality, age, and gender or employment status.
- Adhere to relevant Code of Practice of Professional body (if appropriate).
- The post holder must be flexible in the duties performed and it is expected that similar duties, not specifically listed above, will be carried out as required and may be cross site.
Job description
Job responsibilities
Provide clinical expertise for CHC appeals, and retrospective reviews
Ensure that processed outlined within the National Framework process has been robustly applied within the Appeal, retrospective review and dispute process, with evidence to support CHC eligibility recommendations and decision making
Co-ordinate and Chair both local resolution and retrospective review meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility
Meet with patients/representatives in potentially highly contentious situations and provide responses to complex CHC-related challenges. This can include via telephone, via video call or in person (as required)
Be expected to engage with patients and public in a meaningful way in relation to CHC appeals and retrospective reviews (including leading on the stage 1 clinical call process)
Ensure patient/families/representatives are supported and aware of the appeal and retrospective review processes followed by the ICB in relation to CHC
Complete detailed, accurate and efficient reviews of all evidence sourced
Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments
Attend with Line manager to present and defend CHC cases at NHS England's 'Independent Review Panels' on behalf of the ICB
Support Line Manager to review CHC appeals and retrospective review processes to identify any opportunities to improve pathways as appropriate to enhance quality and effectiveness
Job description
Job responsibilities
Provide clinical expertise for CHC appeals, and retrospective reviews
Ensure that processed outlined within the National Framework process has been robustly applied within the Appeal, retrospective review and dispute process, with evidence to support CHC eligibility recommendations and decision making
Co-ordinate and Chair both local resolution and retrospective review meetings and provide the expert clinical CHC advice at the meetings where patients/families have disputed decisions or requested back dated reviews of eligibility
Meet with patients/representatives in potentially highly contentious situations and provide responses to complex CHC-related challenges. This can include via telephone, via video call or in person (as required)
Be expected to engage with patients and public in a meaningful way in relation to CHC appeals and retrospective reviews (including leading on the stage 1 clinical call process)
Ensure patient/families/representatives are supported and aware of the appeal and retrospective review processes followed by the ICB in relation to CHC
Complete detailed, accurate and efficient reviews of all evidence sourced
Provide timely relevant correspondence to patients/families/representatives ensuring they are kept informed of developments
Attend with Line manager to present and defend CHC cases at NHS England's 'Independent Review Panels' on behalf of the ICB
Support Line Manager to review CHC appeals and retrospective review processes to identify any opportunities to improve pathways as appropriate to enhance quality and effectiveness
Person Specification
Experience
Essential
- Educated to degree level in relevant subject or equivalent level of experience of working at a similar level in a specialist area
Knowledge
Essential
- A good understanding of the health and social care environment and roles and responsibilities within it
Analytical skills
Essential
- Ability to analyse and interpret information, pre-empt and evaluate issues and recommend appropriate course of action to address the issue
Management skills
Essential
- Ability to engender trust and confidence and demonstrate integrity in the provision of advice and support
Person Specification
Experience
Essential
- Educated to degree level in relevant subject or equivalent level of experience of working at a similar level in a specialist area
Knowledge
Essential
- A good understanding of the health and social care environment and roles and responsibilities within it
Analytical skills
Essential
- Ability to analyse and interpret information, pre-empt and evaluate issues and recommend appropriate course of action to address the issue
Management skills
Essential
- Ability to engender trust and confidence and demonstrate integrity in the provision of advice and support
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.
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).
Additional information
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.
UK Registration
Applicants must have current UK professional registration. For further information please see
NHS Careers website (opens in a new window).