Appeals and Retros Clinical Manager

Triage all appeal and retrospective review referrals, liaising with applicants to make sure each referral holds enough information to trigger a full appeal or retrospective review.

Manage a delegated caseload of CHC appeal and retrospective review cases, scrutinising clinical records, care plans, Decision Support Tools and MDT evidence against the National Framework, and prioritising work so that statutory and internal timescales are met.

Write clear, evidence-based rationales, appeal summaries, case reviews and eligibility recommendations for Local Resolution Meetings, Independent Review Panels and internal governance panels.

Represent SWL ICB AACC at Independent Review Panels hosted by NHS England, presenting cases with empathy and professionalism and offering assurance and apology where needed.

Communicate sensitive and complex information, including diagnosis, prognosis and life-changing decisions, to clients, families, staff, NHS England and partner organisations.

Quality assure Decision Support Tools, checklists and appeal documentation, and develop and monitor clinical standards, audit and peer review for the service.

Act as an advocate for vulnerable people, challenging poor practice and discriminatory behaviour and escalating safeguarding and clinical concerns promptly.

Track the financial risk linked to appeal and retrospective cases, and make sure any financial restitution is carried out promptly and in line with Standing Financial Instructions.

Deputise for the Clinical Lead, support the allocation of the team's workload against KPIs, and contribute to staff recruitment, induction, appraisal, training and development.

Support complaint investigations, policy and procedure development, training for health and care providers, and the sharing of best practice across the service.

Please refer to the Job Description for full details.

On 1 July 2022, NHS South West London Integrated Care Board (ICB) was established. The ICB, as part of South West London Integrated Care System (ICS), is a partnership of organisations that come together to plan and deliver joined up health and care services to improve the lives of people in our six boroughs: Croydon, Merton, Kingston, Richmond, Sutton and Wandsworth.

an Integrated Care Board, bringing the NHS together with its partners locally to improve health and care services

an Integrated Care Partnership (ICP): the broad alliance of organisations and representatives concerned with improving the care, health and wellbeing of the population, jointly convened by the ICB and local authorities in the area.

ICBs are statutory NHS bodies responsible for planning and allocating resources to meet the four core purposes of integrated care systems (ICSs):

to improve outcomes in population health and healthcare;

tackle inequalities in outcomes, experience and access;

enhance productivity and value for money and;

help the NHS support broader social and economic development.

NHS South West London Integrated Care Board decides how the South West London NHS budget is spent and develops plans to improve people's health, deliver higher quality care, and better value for money.

Essential: - Registered health professional with current professional registration (e.g. NMC, HCPC); - Degree or equivalent level of experience in health or social care; - Advanced clinical assessment skills

Desirable: - Management qualification

Essential: - Experience of operational service management, change management and service improvement, including leading successful projects

Desirable: - Experience of managing appeal and retrospective cases, and presenting at Independent Review Panels (IRP) with NHS England

Essential: - Excellent knowledge of AACC national and local policy, including the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, and working knowledge of all aspects of AACC (Clinical, Brokerage, Contracting, Finance, Business Intelligence and Quality)

Desirable: - Knowledge of service performance management and driving performance using complex data

Essential: - Ability to analyse very complex, conflicting information drawn from multiple sources, and to write comprehensive reports that can be understood by health and social care professionals and lay people; - Ability to communicate sensitive and complex decisions to clients, families, professionals and other stakeholders, and to manage conflict and challenging behaviour with tact, diplomacy and empathy; - Able to make evidence-based decisions on incomplete information, and to plan and manage own workload over short, medium and long-term timeframes to tight and changing deadlines; - Experience of setting up and implementing internal processes and procedures

Essential: - Acts as a leader while being a good team player; able to challenge and support others appropriately and to promote equality of opportunity and good working relations

Essential: - Demonstrates commitment to NHS and organisational values, and role-models compassionate, inclusive leadership that supports equality, diversity, belonging and inclusion