Community High Intensity Nurse Case Manager - Countywide

Job description

Be part of our BHT family

Buckinghamshire Healthcare NHS Trust (BHT) is an integrated provider of acute hospital and community services for people living in Buckinghamshire and the surrounding area.

We care for over half a million patients every year:

• Provide specialist spinal services at our world renowned National Spinal Injuries Centre at Stoke Mandeville Hospital, the birthplace of the Paralympics
• Nationally recognised for urology and skin cancer services
• Regional specialist centre for burns, plastic surgery, dermatology, stroke and cardiac services
• Deliver community services in health centres, schools, patients' own homes, community hospitals and community hubs.

More than 6,500 people from different nations, cultures and backgrounds work for us.

We would be happy to discuss possible flexible working options. We strive to be a family friendly, inclusive employer.

If you require any assistance in making this application, please contact [email protected] or phone 01494 734868.

We pride ourselves in being a great place to work and invite you to join our BHT family.

Job overview

An exciting opportunity has arisen for a motivated and experienced Qualified District Nurse to join our Community High Intensity User Service as a Nurse Case Manager.

This innovative role focuses on supporting individuals who frequently access urgent and emergency healthcare services and often have complex physical health, frailty, mental health or social care needs. Through proactive case management, comprehensive assessment and coordinated multidisciplinary working, you will help patients achieve better health outcomes while reducing avoidable Emergency Department attendances and hospital admissions.

Working across community, primary care, acute, mental health, social care and voluntary sector services, you will develop personalised care plans that address the underlying causes of repeated healthcare use. You will build strong therapeutic relationships with patients, families and carers, supporting individuals to access the right care, at the right time, in the right place.

This is an excellent opportunity to contribute to an innovative service that improves patient experience, promotes independence and supports more effective use of healthcare resources across the Buckinghamshire healthcare system.

Main duties of the job

The postholder will manage a designated caseload of high intensity users, undertaking comprehensive holistic assessments and developing personalised care plans to address complex health and social care needs. They will act as the lead coordinator for patients requiring multi-agency input, ensuring effective communication and collaboration between primary care, community services, acute trusts, mental health services, ambulance services, social care and voluntary sector organisations.

The Community High Intensity User Nurse Case Manager will proactively monitor patients at risk of deterioration, provide timely interventions following emergency department attendances, hospital admissions or discharge, and lead multidisciplinary reviews to support coordinated care delivery. They will work closely with patients and carers to promote self-management, facilitate advance care planning and develop crisis and escalation plans that reduce avoidable admissions and emergency service use.

The postholder will also contribute to service development, quality improvement and outcome measurement, providing specialist advice, education and support to colleagues across the wider healthcare system. Through strong clinical leadership and partnership working, they will help deliver improved patient experience, enhanced health outcomes and more effective use of healthcare resources.

Working for our organisation

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