Population Health Care Manager Complex Care Manager PRN

Duke University; Durham (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Duke University Hospital seeks a skilled Case Manager to oversee Complex Care patients across the continuum of care in Durham, NC. The role emphasizes discharge planning, care coordination, and efficient use of health system resources.

BSN highly preferred; requires Case Management Certification within 2 years; RN licensure in NC; 3 years of hospital case management experience; strong communication and problem solving are essential.

Qualifications

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

Responsibilities

• Monitor daily census and ensure all patients are assessed.
• Coordinate discharge planning and care transitions across the continuum.
• Communicate assessment findings and discharge needs with health care team and providers.
• Maintain knowledge of benefits, reimbursement guidelines, and regulations.
• Provide education and guidance to providers, patients and families.
• Collaborate with Utilization Management to support payer negotiations and minimize denials.
• Document assessments and discharge actions in a timely manner.

Skills

Self-directed work

Multi-tasking

Written & verbal skills

Computer skills

Education

BSN

MSW

Job description

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 its surrounding 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.