Clinical Lead PUPoC & AppealsNHS

Job summary

The Clinical Lead for PUPoC and Appeals will work as part of the management team to embed a culture of quality improvement & drive clinical workforce development.

The Clinical Lead will work closely alongside the Head of Clinical Operations to develop and ensure the service delivery of contracts for Retrospective Reviews and Appeals in line with the PUPoC guidance.

Delivering value to the business: The Clinical Lead for Retrospective Reviews and Appeals will work with all functions of the business to support in the clinical delivery of contracts, ensuring adherence to clinical best practice to ensure the National Framework process has been robustly applied. Work to timescales in line with National NHS guidance.

Developing/implementing quality improvement programmes.

Demonstrate sound Clinical Leadership in the development, mentoring and teaching of the team within the speciality of PUPoC and Appeals.

Support/Deputise for Head of Clinical Services- Retrospective Reviews/Appeals and LeDeR.

As The Clinical Lead in PUPoC and Appeals you will operate as:

A subject matter expert in retaining current customers and developing scope for potential new business opportunities.

A Collaborative problem solver with a solution focused approach, whilst adhering to legislative requirements

A Strong Leader and team builder, bringing together the excellence of workforce, operational and clinical teams.

Main duties of the job

High level overview of National Framework for NHS CHC, NHS FNC, PUPOC & relevant impacting legislation.

Complete complex clinical triage across PUPoC-Appeals and highlight potential risks to customers and agree actions.

Complete outcome letters where required on behalf of the customer giving decisions on eligibility supported by DST evidence including Four Key Characteristics.

Attend Customer meetings as agreed at mobilisation and provide clinical support in risks, process and delivery in line with NHS CHC Framework/PUPOC guidance.

Lead in mobilisation of new contracts for PUPoC and Appeals.

Play an active part in ensuring business retention across all PUPoC/Appeal contracts.

Support Head of Clinical Operations in the recruitment of Clinicians for Retro/Appeals including selection/interviews/supervision.

Lead in the clinical support and development to Clinical Team and admin support.

Support staff ensuring quality is established/preserved.

Oversee quality improvement programmes and monitor the effectiveness of current process.

Safeguarding Service Users through the development & use of systematic processes, reporting & monitoring.

Effectively manage incidents and complaints using internal systems.

To maintain an awareness of new and updated guidance in NHS Continuing Healthcare in particular that applicable to Retros and Appeals.

Job description

Ensure the correct legislation is followed within service delivery. Understand the financial elements of contract delivery and work within constraints where needed whilst maintaining clinical safety and quality. Implement quality improvement programmes to ensure compliance and quality. Oversee quality, audit and sign off process to ensure it remains effective in maintaining expected standards of quality.

High level overview of National Framework for NHS CHC, NHS FNC, PUPOC & relevant impacting legislation.

Complete complex clinical triage across PUPoC-Appeals and highlight potential risks to customers and agree actions.

Complete outcome letters where required on behalf of the customer giving decisions on eligibility supported by DST evidence including Four Key Characteristics.

Attend Customer meetings as agreed at mobilisation and provide clinical support in risks, process and delivery in line with NHS CHC Framework/PUPOC guidance.

Lead in mobilisation of new contracts for PUPoC and Appeals.

Play an active part in ensuring business retention across all PUPoC-Appeal contracts.

Support Head of Clinical Operations in the recruitment of Clinicians for Retro/Appeals including selection/interviews/supervision.

Lead in the clinical support and development to Clinical Team and admin support.

Support staff ensuring quality is established/preserved.

Oversee quality improvement programmes and monitor the effectiveness of current process.

Safeguarding Service Users through the development & use of systematic processes, reporting & monitoring.

Effectively manage incidents and complaints using internal systems.

To maintain an awareness of new and updated guidance in NHS Continuing Healthcare in particular that applicable to Retros and Appeals.

About us

About UB Healthcare

UB Healthcare is a fast-growing healthcare start-up delivering outcome-based services for the NHS and social care sector. Our mission is to improve outcomes, reduce inequalities, and elevate experiences through collaborative partnerships and cost-effective, high-quality services.

We are proud to be an equal opportunity, Living Wage, and Mindful Employer.

Our environment includes:

A safe and inclusive workplace On-the-job training Wellness programmes Growth and promotion opportunities Regular social events