Population Health Care Manager Complex Care Management

Duke Health; Durham (NC); Sur place; USD 70 000 - 95 000; Plein temps

Résumé du poste

Duke Health is seeking a qualified case manager for Complex Care at Duke Connected Care to coordinate discharge planning and care transitions across the continuum of care for Medicare patients in Durham and surrounding areas.

Ideal candidates will have a BSN or MSW, 3 years of hospital case management experience, and obtain a Case Management Certification within 2 years of hire while maintaining RN licensure in North Carolina. Join a collaborative team focused on high-quality patient outcomes.

Qualifications

• Requires BSN or MSW.
• 3 years of relevant hospital case management experience is preferred.
• Case Management Certification (ACM/CCM/ANCC) within 2 years of hire; RN licensure in NC.

Responsabilités

• Monitor daily census and patient assignments.
• Coordinate and complete timely discharge planning and care transitions.
• Communicate with care team about assessment findings and discharge needs.
• Coordinate Homecare, Durable Medical Equipment, transportation, and skilled nursing facility placement.
• Maintain documentation and participate in QA/QAPI activities.

Connaissances

Self-directed work

Multi-tasking

Communication skills

Computer skills

Formation

BSN or MSW

Description du poste

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.

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

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.