Duke University

Private research university in Durham, NC

Population Health Care Manager Complex Care Management

Medical, Clinical & VeterinaryUpdated on Nov 14

Full-timeDurham, NC, USANo salary listedIn-person

About the Job

Requirements

A BSN or MSW is required.
Three years of relevant experience is required; hospital case management experience is preferred.
Case Management Certification (ACM, CCM, or ANCC) is required within two years of hire.
A current or compact RN license in North Carolina is required for candidates with a BSN.
Ability to work effectively in a self-directed role and manage multiple tasks while solving complex issues.
Basic computer skills are required.
Strong written and verbal skills are required.

Responsibilities

Manage complex care patients in a variety of areas at Duke University Hospital and a designated caseload, coordinating and completing timely assessment, planning, implementation, and evaluation of discharge plans and care transitions across the continuum of care.
Ensure optimum use of patient and Health System resources while complying with CMS and other external review agency requirements.
Monitor daily census and assignments to ensure all patients are assessed.
Coordinate case management needs, including care transitions, discharge planning, consultations, advocacy, and education.
Communicate assessment findings, discharge planning needs, and provider orders to the health care team to arrange home care, durable medical equipment, transportation, skilled nursing or acute rehabilitation placement, substance abuse treatment, and outpatient follow-up.
Maintain working knowledge of benefits and reimbursement guidelines, discharge planning processes, and applicable federal, state, and local regulations; provide education and guidance to providers, patients, and families as needed.
Work with Utilization Management partners to provide information and feedback that supports payer negotiations and denial prevention.
Document assessment findings, discharge arrangements, and actions in a timely manner; prepare reports and maintain records as requested or required.
Participate in Quality Assurance/Performance Improvement activities as requested.
Perform site-specific duties and provide weekend, holiday, or after-hours coverage as designated by the entity.
Develop and maintain positive working relationships with internal and external Duke Health System customers.
Perform other duties incidental to the work described.

Desired Qualifications

Hospital case management experience is preferred.
A BSN is highly preferred.

Duke Connected Care, a community-based, physician-led network, includes a group of doctors, hospitals and other healthcare providers who work together to deliver high-quality care to Medicare Fee-for-Service patients in Durham and itssurrounding areas.

BSN Highly preferred for this position

Responsible for Complex Care patients in a variety of areas at Duke University Hospital. Also, manage a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions across the continuum of care. Ensure optimum utilization of the patient's and the Health System's resources and perform these duties within the requirements of CMS and other external review agencies.

Work Performed

Monitor daily census and assignment to assure all patients are assessed.
Perform other related duties incidental to the work described herein.
Case management needs including care coordination/transition and discharge planning, consultations, advocacy, education. Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations.
Provide education and guidance on these topics to providers, patients and families as needed.
Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers.
Maintain timely documentation of assessment findings, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required.
Participate in Quality Assurance/Performance Improvement (QAPI) activities as requested.
Job responsibilities may include site specific duties, weekend/holiday or after hours coverage as designated at each entity.
Develop and maintain positive working relationships with customers internal and external to Duke Health System.

Knowledge, Skills and Abilities

Ability to work effectively in a self-directed role Ability to multi-task, capable of daily problem-solving complex issues Excellent written and verbal skills Basic computer skills necessary

Level Characteristics

N/A

Minimum Qualifications

Education

BSN or MSW required

Experience

3 years of relevant experience; Hospital Case Management preferred

Degrees, Licensures, Certifications

Requires Case Management Certification (ACM, CCM or ANCC) within 2 years or of hire. BSN required and must have current or compact RN licensure in state of NC. MSW

Duke is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex (including pregnancy and pregnancy related conditions), sexual orientation or military status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions:

Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.

About the Company

Duke University

Private research university in Durham, NC

Duke University is a research university offering undergraduate, graduate, and professional education alongside interdisciplinary research and health care.

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