Job summary

The post holder will be responsible for assessing and determining eligibility for people with complex health needs who are eligible for NHS funding for long term care and treatments under The National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care, The Mental Health Act, Transforming Care and Neurological Rehabilitation pathways.

The post holder has responsibility to clinically plan and commission the care required, ensuring that the care is safe, effective and good quality. Communication and relationships with individuals and independent providers are a key part of this role as well as abilities to manage risks, problem solve influence and negotiate to ensure appropriate clinical commissioning case management of complex individuals.

Main duties of the job

• The post holder will act as Individualised Commissioning Nurse for a defined caseload of patients whose care is either jointly or solely funded by NHS GM and the care is provided by the independent sector.
• Identify and case manage any clients in a nursing home who may be eligible for NHS funding, to chair and coordinate eligibility assessments and reviews. This includes representing NHS GM in the ratification of decisions for NHS Continuing Healthcare and NHS Funded Nursing care and on duty.
• Act as Commissioning Case Manager for all individualised commissioned placements, purchased by NHS GM.
• Conduct contractual monitoring ensuring that contracts in place for individual clients in receipt of NHS funding are being adhered to as well as supporting and enabling providers to improve the quality-of-care delivery.
• Provide expert advice to other professionals commissioned to provide care in relation to NHS Individualised Commissioning.
• Complete the restitution process for all claims which includes presentation of findings to NHS GM multi-agency funding panel and the NHS England Independent review panel.
• Jointly conduct contract performance visits to ensure contractual obligations and quality care standards are being met.

About us

Integrated Care Systems (ICSs) are partnerships of health and care organisations that come together to plan and deliver joined up services and to improve the health and wellbeing of people who live and work in their area. Their purpose is 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 efficiency. This will be delivered in the neighbourhood, place, combinations of places and GM system.