Purpose of Job: Role is responsible for providing clinical review and triage of referrals within the RS services across Optum , utilizing approved medical protocols per policy, and recommending an appropriate level of clinical care based on clinical judgment and protocols. To act as an expert clinical resource for the RS teams supporting the Lead Nurse and Head of Operations in clinical training, complaint resolution and quality improvement.
Job Scope and Guidelines
- Uses pertinent data and facts to identify and solve a range of problems within area of expertise.
- Investigates non-standard requests and problems, with some assistance from others.
- Works exclusively within a specific knowledge area.
- Prioritizes and organizes own work to meet deadlines.
- Provides explanations and information to others on topics within area of expertise
Main Duties & Responsibilities:
- Clinically triage referrals in line with agreed specialties ensuring that they meet the referral criteria for onward booking
- Analyzes and investigates.
- Provides explanations and interpretations within area of expertise
- Where a referral does not meet the criteria or there is clinical information missing the referral should be returned to the referrer with clear advice and guidance as to the reasons – this will then go through to a GP to provide secondary triage and either confirm or disagree with the original triage decision
- Where a referral does meet the criteria provide the referrer with advice and feedback on their referral if appropriate.
- To keep clinical quality at the forefront of all decision making within the RFS
- Triage all referrals within productivity timelines
- Provide high quality and comprehensive feedback to referrers on the quality of their referrals
- Utilise best practice guidance for all referrals processed within the RFS
- Through the triage process highlight any concerns around quality of referrals from specific GPs or practices
- Liaise with GP Triager colleagues on difficult or challenging referrals.
- To utilise the RFS systems accurately and fully for the purposes of comprehensive data collection
- Support the development of clinical protocols and guidelines for the RFS services
- Quality audit clinical triage and work with colleagues to demonstrate the value of clinical triage
- Provide coaching and support on clinical terminology and referral pathways to RFS team
- Provide the admin teams with clinical expertise, knowledge and support.
- Participate and support the GP and consultant Triage meetings
- Contribute to the development of improved ways of working within the RS
- Maintain a high level of confidentiality in all aspects of work including participant records and conversations.
- Maintain accurate information systems of records and activities
- Adhere to organisational policies and procedures including clinical governance and patient confidentiality
- Communicate professionally and effectively with participants and all other stakeholders, providing accurate, relevant information as required.
- Communicate across language and cultural barriers within groups in partnership with the available agencies.
- Provide excellent customer service
- Manage all calls in a customer focused and professional manner.
Professional & Educational Development:
- Provide a high standard of care at all times in accordance with the Code of Professional Conduct (NMC 2015) and any other company policy or procedural requirements.
- Develop a Personal Development Plan that both fulfills the requirements of the post and allows for personal and professional development.
- Undertake refresher training to maintain clinical triage skills
- Participate in any mandatory training for the role and undertake any additional necessary training to undertake the role competently and efficiently.
- Engage in clinical supervision and self-evaluation using this as a method to improve care and practice.
- Ensure patient confidentiality at all times in accordance with the Code of Professional Conduct (NMC 2015) and other service and corporate requirements.
- Positively engage in the Maximising Accountability and Performance (MAP) process
The role is based in our Ealing offices, the successful applicant should live near-by or at least a commutable distance.