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Case Manager

Job Description

The Case Manager role has been created to increase health and wellbeing, access to integrated health services and promote excellent practice in holistic care across the community health teams. The role will be with the Case Management team, supporting individuals with complex, long term health conditions and/or high use of primary and secondary services and/or social isolation, substance misuse and poor mental health.

This role requires a dynamic, passionate, flexible, problem solver and critical thinker with the ability to work across organisations, engaging patients and stakeholders creatively, role modelling and facilitating change. Your work will be highly focussed, ensuring that a person’s health and psychosocial needs are appropriately assessed and an appropriate care plan is formulated and completed. You will continue the links already in place with other health partners, voluntary sector, LAS, and Social Services and build new relationships to ensure the best possible outcomes for our patients and best practice. Your work as a Case Management will be alongside experienced RGNs and RMNs (including a Nurse Prescriber), B4 Care Navigators, a Medication Optimisation Pharmacist in your team, and more widely across the organisation with Specialist teams including Dementia, End of Life, Respiratory, OT, Physio, Diabetes, Dieticians.

We are aware as a Trust which that working interactively with Mental and Physical health services is significant. Though it may appear challenging, it is the cultural shift inherent in moving organisations generally.

This is a very exciting and amazing opportunity! The role would suit an RMN or a dual RMN/RGN registered Practitioner with experience of working with clients that have/ experience varied, diverse and complex determinants of health.

To ensure that you are effective in your new role, we provide support for your professional development and study leave. We will also support your induction process and facilitate shadowing days across our locality so that you can understand how each team works as part of the greater whole. Clinical supervision will be key to your development and we are committed to ensuring that as well as management supervision with the Clinical Ops Manager, we will arrange for regular 1:1 supervision with suitably qualified Supervisors within the Trust.

Central London Community Healthcare (CLCH) is one of the largest community healthcare organisations in London and Hertfordshire, providing our services to diverse communities/boroughs in 11 London Boroughs - Barnet, Brent, Ealing, Hammersmith & Fulham, Harrow, Hounslow, Kensington and Chelsea, Merton, Richmond, Wandsworth, Westminster - and Hertfordshire.

• To actively identify very high intensity users and coordinate advanced physical assessments, diagnostic, prescribing delivery and evaluation of the highest standard of clinical care provided to patients within the integrated locality teams.
• To proactively monitor and anticipate the changing needs of the patients, co-ordinating their care across health and social care system.
• To co-ordinate care provision through a case management approach for a defined high risk patient group with complex long term conditions, within integrated locality teams with the aim to avoid inappropriate admission to hospital or long term care environments and facilitate timely discharge.
• To participate in the delivery of educational programmes to patients, carers and health and social care workers that promotes self-care principles.
• To develop and promote robust multidisciplinary working across the wider Health and Social care sectors to ensure integrated service and support networks for patients.
• To monitor the quality of care provision and to identify and promote areas for service development whilst maintaining focus on improved clinical and patient experience outcomes

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