Population Health Complex Care Manager, Pediatrics
Duke Careers
full-time
Posted on:
Location Type: Office
Location: Durham • North Carolina • United States
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About the role
- Responsible for Complex Care patients in a variety of areas at Duke University Hospital.
- 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.
- Perform duties within the requirements of CMS and other external review agencies.
- 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.
- Develop and maintain positive working relationships with customers internal and external to Duke Health System.
Requirements
- BSN or MSW required
- 3 years of relevant experience; Hospital Case Management preferred
- 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
Benefits
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementcare coordinationdischarge planningassessmentevaluationdocumentationquality assuranceperformance improvementutilization managementreimbursement guidelines
Soft Skills
communicationadvocacyeducationrelationship buildingteam collaboration
Certifications
ACMCCMANCC