Proactive Care Lead, High Intensity Service Users

Job summary
Are you passionate about improving outcomes for people with complex health and social care needs? We are seeking an experienced and motivated Proactive Care Lead to identify, coordinate and support high intensity service users who frequently access healthcare services. You will work collaboratively across primary care, community, acute, mental health and voluntary sector partners to develop personalised care plans, reduce health inequalities, and promote independence. The successful candidate will demonstrate strong leadership, excellent communication skills, and a commitment to delivering person-centred care. This is an exciting opportunity to drive innovation, improve patient experience, and support sustainable healthcare delivery across the system.

A full UK driving license is essential for this post. Please note that an international driving license is not accepted.

Closing Date: Please be advised that this job advert will close as soon as sufficient applications have been received. Please apply for this job as soon as you can, if interested.

Secondment will be considered for internal candidates - If you are successful after interview, you must obtain approval from your current line manager to accept the offer.

Successful applicants will be required to provide an immunisation and vaccination report, from either their current UK occupational health provider or their UK GP.

Main duties of the job

• Proactively identify and support high intensity service users who frequently access acute, community, primary care, urgent and emergency care services, ensuring their needs are assessed holistically and managed through coordinated care planning.
• Undertake comprehensive assessments of individuals with complex health, social, psychological, and behavioural needs to understand the factors contributing to high service utilisation and identify opportunities for alternative approaches to care.
• Develop, implement, and regularly review personalised care and support plans that promote self-management, improve health outcomes, and reduce avoidable healthcare attendance and admissions.
• Work collaboratively with multidisciplinary teams, including acute, community, primary care, mental health, social care, and voluntary sector services, to coordinate appropriate interventions and ensure seamless care delivery.
• Act as a key point of contact for high intensity service users, providing case management, advocacy, and support to navigate services and access the most appropriate care pathways.
• Identify patients who may benefit from receiving care in alternative settings, such as community services, primary care, outpatient clinics, or other specialist support services, ensuring care is delivered in the most appropriate and least restrictive environment.
• Monitor patterns of service utilisation and identify trends, risks, and opportunities for intervention to improve patient outcomes and reduce unnecessary demand on healthcare services.
• Support the development and implementation of strategies, pathways, and initiatives aimed at improving care for high intensity service users, reducing health inequalities, and promoting integrated care across organisational boundaries.
• Maintain accurate records, collect relevant data, and contribute to service evaluation, quality improvement, and reporting requirements to demonstrate outcomes and inform future service development.
• Build effective relationships with patients, carers, families, and partner organisations to promote person-centred, coordinated care that improves patient experience and quality of life.

About us
University Hospitals Coventry and Warwickshire NHS Trust, rated as good by the Care Quality Commission, is one of the largest teaching Trusts in the UK.

We are extremely proud of our employees across our hospital sites, with high quality patient care at the heart of everything we do.

Boasting some of the most modern facilities in Western Europe, the Trust is renowned for being at the forefront of research and innovation as part of its blossoming reputation as a worldwide leader in healthcare.

We are proud to be recognised as a Pathway to Excellence designated organisation - please click the link for further details about this prestigious award. Pathway To Excellence - University Hospitals Coventry & Warwickshire (uhcw.nhs.uk)

By joining our exciting journey, you will form part of a passionate, talented team and will be able to access a wide range of learning and development opportunities. There has never been a better time to join our team.

The Trust is committed to building an organisation that makes full use of the talents, skills, experience, and different perspectives available in our diverse society. We want everyone to feel they are respected, valued, can achieve their potential and receive the most appropriate and relevant care. We will create an environment where the equality and human rights principles of fairness, respect, equality, dignity and autonomy are promoted and are part of the organisation's core values.

Details
Date posted: 14 October 2026
Pay scheme: Agenda for change
Band: Band 8a
Salary: £57,528 to £64,750 a year per annum
Contract: Fixed term
Duration: 12 months
Working pattern: Full-time
Reference number: 218-NM-B8A-8359961
Job locations: Enterprise Centre, University 3, Puma Way, Coventry, CV1 5FB, United Kingdom

Job description
For further details of the role please see the attached job description.

Person Specification
Qualifications
Essential

• Registered healthcare professional (RGN, HCPC or equivalent professional registration).
• Independent prescribing and Advanced Health assessment qualification or expectation to complete within the first 12 months of being in post.
• Degree-level qualification or equivalent experience.
• Evidence of continuing professional development.
• Leadership and management qualification or equivalent experience.
• Master's level study or working towards Master's level qualification, or equivalent experience.
• Training in quality improvement, service redesign, population health management or personalised care.

Desirable

• Coaching, mentoring or supervision qualification.
• Project or programme management qualification.
• Teaching and assessing qualification.
• Coaching qualification.

Experience
Essential

• Significant experience within community, primary care, integrated care or neighbourhood services.
• Experience leading multidisciplinary teams and managing change across organisational boundaries.
• Experience of service transformation and implementation of new models of care.
• Experience developing and delivering personalised care and support planning.
• Experience of partnership working across health, social care, voluntary and community sectors.
• Experience of leading quality improvement programmes and service evaluation.
• Experience managing complex clinical or operational situations.

Desirable

• Experience of working within an Integrated Care System.
• Experience of Population Health Management approaches.
• Experience of securing and evaluating programme outcomes.

Knowledge
Essential

• Extensive knowledge of personalised care, proactive care and anticipatory care approaches.
• Understanding of integrated neighbourhood working and place-based care models.
• Knowledge of clinical governance, safeguarding and risk management.
• Understanding of current NHS policy, integrated care and neighbourhood transformation agendas, National neighbourhood health programme.
• Knowledge of reducing health inequalities and addressing wider determinants of health.

Desirable

• Knowledge of population analytics and outcomes measurement.
• Knowledge of research and evaluation methodologies.
• Experience of admission avoidance, anticipatory care planning, personalised care and support planning, and proactive interventions to improve patient outcomes.
• Experience developing, implementing and evaluating personalised care, proactive care or population health management approaches/risk stratification.

Skills
Essential

• Strong strategic and operational leadership skills.
• Excellent communication and influencing skills.
• Ability to build effective relationships across organisational boundaries.
• Ability to analyse and interpret complex data and information.
• Ability to develop policies, pathways and service standards.
• Skilled in presentation, facilitation and report writing.
• Ability to manage competing priorities and deliver agreed objectives.
• Strong problem-solving and decision-making skills.
• Competent IT and digital skills.
• A full UK driving license.

Desirable

• Advanced project management skills.
• Experience of workforce development and educational programme design.

Commitment to Trust Values and Behaviours
Essential

• Must be able to demonstrate behaviours consistent with the Trust's values (as detailed in UHCW's Values in Action document).
• Applicants applying for job roles with managerial responsibility will be required to demonstrate evidence of promoting equal opportunities through work experience.

Disclosure and Barring Service Check
This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship
Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website.

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here: Criminal records checks for overseas applicants.

UK Registration
Applicants must have current UK professional registration. For further information please see NHS Careers website.

Employer details
Employer name: University Hospitals Coventry and Warwickshire NHS Trust
Address: Enterprise Centre, University 3, Puma Way, Coventry, CV1 5FB, United Kingdom
Employer's website:

Employer contact details
For questions about the job, contact: Lead Nurse, Place, Nikki Wise, View email address on meeveem.com, View phone number on meeveem.com

Privacy notice
University Hospitals Coventry and Warwickshire NHS Trust's privacy notice.