Population Health Care Manager Complex Case Management

Duke University; Durham (NC); On-site; USD 85,000 - 120,000; Full time

Job summary

Duke Connected Care in Durham seeks an experienced case manager to optimize patient transitions and care coordination within a physician-led network serving Medicare Fee-for-Service beneficiaries. You will work across homecare, equipment, transportation and rehab placement, collaborating with the care team to ensure safe, efficient discharges.

The role requires clinical education (BSN/MSW) and 3 years of CM experience, with certification within 2 years of hire.

Qualifications

• BSN or MSW required.
• 3 years of relevant experience; Hospital Case Management preferred.
• Requires Case Management Certification (ACM, CCM or ANCC) within 2 years of hire.
• RN licensure in NC (current or compact).

Responsibilities

• Monitor daily census and assign patients for assessment.
• Coordinate discharge planning and arrange Homecare, DME, transportation.
• Provide education and guidance to providers, patients and families.
• Assist Utilization Management in payer negotiations and denial prevention.
• Document assessments, discharge plans and actions per guidelines.
• Participate in QAPI activities and quality improvement.
• Perform site-specific duties, weekend/holiday or after-hours coverage as designated.
• Build positive relationships with internal and external customers.

Skills

Multi-tasking

Written and verbal communication

Self-directed

Team collaboration

Education

BSN or MSW

Tools

Basic computer skills

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 itssurrounding areas.

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.