Population Health Care Manager Complex Care Manager PRN

Duke Careers; Durham (NC); On-site; USD 55,000 - 77,000; Full time

Job summary

Duke Connected Care in Durham, NC is seeking a Population Health Care Manager Complex Care Manager PRN to oversee complex care patients and coordinate discharge planning across the continuum of care. The role requires a BSN or MSW, 3 years of experience, and Case Management Certification within 2 years of hire.

On-site work with potential after-hours duties may apply. You will collaborate with the care team, utilization management, and providers to ensure efficient care transitions, appropriate

Qualifications

• BSN or MSW required.
• Minimum of 3 years of relevant hospital case management experience preferred.
• Case Management Certification (ACM, CCM or ANCC) within 2 years of hire.

Responsibilities

• Coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions.
• Coordinate resources and documentation to ensure CMS and payer requirements are met.
• Maintain communication with care team regarding discharge planning and follow-up needs.
• Collaborate with Utilization Management to support payoff negotiations and deny prevention.
• Document assessment findings and actions per departmental guidelines; prepare reports as required.
• Participate in Quality Assurance/Performance Improvement activities.

Skills

Multi-tasking

Written and verbal communication

Self-directed work

Problem solving

Basic computer skills

Education

BSN or MSW

Job description

Population Health Care Manager Complex Care Manager PRN

Work Arrangement: On-Site

Requisition Number: 276879

Regular or Temporary: Regular

Location: Durham, NC, US, 27710

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.

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.

Nearest Major Market

Durham

Nearest Secondary Market

Raleigh

Read more about Duke’s commitment to affirmative action and nondiscrimination at hr.duke.edu/eeo.