Clinical Lead for Appeals and Retros

NHS South West London ICB is looking for an experienced, registered healthcare professional to lead our All Age Continuing Care (AACC) appeals and retrospective reviews team as Clinical Lead for Appeals and Retros.

You will be responsible for the central team that manages and delivers appeals and retrospective reviews of people's eligibility for NHS Continuing Healthcare (CHC) and NHS-funded Nursing Care. You will make sure there are clear communication pathways with clients and their representatives, that the National Framework for CHC was followed at the outset, and that the appeals process is followed through each of its stages.

You will lead on representing the ICB at NHS England Independent Review Panels and make sure the learning from them is shared with AACC teams across the ICB. Working closely with the AACC service, local authorities and other partners, you will help develop, analyse and improve the service, and you will line manage the Appeals and Retros Clinical Manager.

You will be a registered nurse (adult), occupational therapist or physiotherapist with a postgraduate qualification, an excellent knowledge of the National Framework, and experience of managing appeal and retrospective cases and presenting at Independent Review Panels. You will also have experience of leading a team, working in politically sensitive settings, and managing risk and budgets.

Main duties of the job

• Manage the appeals and retrospective caseload where a CHC eligibility decision is being appealed or a retrospective assessment is requested for a period of unassessed care, making sure the service meets local, regional and national standards.
• Lead on representing SWL ICB AACC at Independent Review Panels hosted by NHS England, presenting cases with empathy and professionalism and offering assurance and apology where needed.
• Collate NHS England feedback from Independent Review Panels and share the learning with the wider AACC team to embed good practice and improve ways of working.
• Represent the service at multi-agency meetings and with NHS, local authority and other partner organisations.
• Lead on communication within the appeals and retrospective process, including decision letters, supporting documentation and correspondence, making sure it meets quality and assurance standards.
• Investigate complaints and provide outcomes, making sure the learning is shared with the AACC team and standard operating procedures are updated where needed.