Job Description Title: Integrated Care Project Manager Reports to: Chief Executive Officer Place of work: 67 High Street, Thornbury and at GP practices throughout South Gloucestershire Hours of work: 37.5 hours per week Monday to Friday (to be worked flexibly as agreed with the Line Manager) Salary : £23,945 p.a. plus up to 7% pension following successful completion of probationary period Holiday: 28 days annual leave plus 8 public holidays Tenure: 15 month fixed term contract. (There is the possibility that this term may be extended depending on the outcome of the initial pilot.) Purpose of the Job This is an innovative role working collaboratively as part of a pilot local integrated prevention team to improve the co-ordination and quality of care resulting in improved outcomes for individuals, their carers and families. If successful the project could be rolled out across South Gloucestershire. The post will be part of a South Gloucestershire wide team with a range of partners including social care, community nursing and GPs. The Integrated Care Project Manager will form a key role within the team providing regular contact, liaison, brokerage and support planning to identify patients, their carers and families. The purpose is to offer a supportive presence, not to duplicate the services provided by other agencies, and to ensure that services and support is delivered in a personalised, coordinated, relevant and timely way. The Integrated Care Project Manager’s role is crucial to the delivery of personalised planning and will offer encouragement and support for individuals to self-manage and self-care using the best practice available. The nature of this post will require travel therefore a requirement of this post will be access to and the use of a reliable car and a current driving licence. As duties and responsibilities change, the job description will be reviewed and amended in consultation with the post holder: Key Responsibilities: Develop and implement a detailed project delivery plan Develop project methodology as pilot evolves and assess options for future roll out. Ensure an interim and final independent project evaluation is undertaken Manage and help to train volunteers working as part of the locality team, to offer initial visits, guided conversations and “checklist” reviews to individuals identified within the programme. Visit individuals within the programme to undertake assisted self-assessments within a format agreed by partner agencies. Develop a support plan, liaising with relatives, carers and other involved agencies as agreed with the individual to ensure an integrated and personalised approach to care and support. Liaise with other Age UK South Gloucestershire services and ensure appropriate links are made to other services. Provide accurate and timely performance reporting. Understand and assist to identify triggers and developing protocols for ensuring any deterioration results in an appropriate and timely response. Work with team members and other local organisations, statutory, voluntary and independent organisation to ensure referrals are made appropriately. Understand the range of specialist clinical and support teams who can provide assistance to an individual and their carer or family. Develop and monitor an outcomes star monitoring framework. Work as part of the Integrated Care Team to motivate and encourage older people to improve mobility and become, and remain, more physically active through involvement in community services and social activities. General Attend mandatory training and meetings as directed by the Line Manager. Uphold the highest standards of personal conduct in all matters relating to the role. Work within all policies and procedures of Age UK South Gloucestershire, such as Health & Safety, Equality and Diversity, Lone Working, Confidentiality and Data Protection and Safeguarding Adults, ensuring that client and carers’ information remains confidential. Such other duties which are consistent with the duties and responsibilities of this post as required by the Chief Executive Officer of Age UK South Gloucestershire This post will involve some lone working therefore the advice and guidance of Age UK South Gloucestershire must be followed. Person Specification - This person specification details the experience, skills, knowledge, personal qualities and qualifications that are either essential or desirable for the post Knowledge and skills Essential: 1. Understanding the role of prevention and voluntary sector activities 2. Appreciation of issues impacting on individuals, their carers and families in having a long term condition 3. Ability to report and provide performance management information 4. Ability to work effectively as part of a multi-disciplinary locality team 5. Experience in managing and supporting volunteers 6. Communicate effectively and have good interpersonal skills in a variety of environments, some of which could be potentially unpredictable 7. Problem solve 8. Be self-motivated and enthusiastic 9. Plan, prioritise and work to timescales 10. Personal care and support planning skills 11. Community development skills 12. Experience and knowledge of self-care and self-management opportunities 13. The principles of Integrated Care 14. Understanding of issues affecting cognition and communication Desirable: 15. Motivational interviewing skills 16. Developing social capital Disclosure and Barring Service This post is subject to a satisfactory Disclosure and Barring Service check, which will disclose all cautions reprimands and warnings as well as convictions. In addition to completing this application form you are required to provide us with details of all spent and unspent convictions. Please send this information to us under separate, confidential cover to the Chief Executive Officer. Remember to include your name, address and the position for which you are applying. We guarantee that the information you provide be used fairly and will only be seen by those who need to see it as part of the recruitment process. A criminal record will not necessarily bar you from the advertised position. This will depend on the nature of the position and the circumstances and background of your offences. However, failure to reveal this information could lead to the withdrawal of an offer of employment.