We are seeking an experienced Band 6 Appeals Nurse to join our team. The primary focus of this role will be to manage and support the clinical review, case management, and decision-making process for both retrospective and current Continuing Healthcare (CHC) appeals. The successful candidate will help reduce an identified backlog, working towards meeting the national six-month appeal response target.
Key Responsibilities
Conduct thorough clinical and documentary reviews of appeal cases, assessing CHC eligibility and needs in line with the National Framework.
Prepare detailed case summaries and recommendations, presenting cases at local resolution and appeal panels as required.
Communicate directly with appellants, families, attorneys, and representatives to explain the appeal process, outcomes, and next steps, ensuring local resolution when possible.
Contribute to maintaining accurate documentation, minimising risks, and ensuring compliance with national timelines to reduce financial, legal, and reputational risks linked to unresolved appeals
Eden Brown Synergy is an equal opportunities employer.
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