Population Health Care Manager – Team Lead, Care Transition

Duke Careers

. Coordinate and facilitate timely implementation of appropriate interventions for identified customer populations following established policies and procedures.

Posted 5/6/2026full-timeRemote • North Carolina • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Coordinate and facilitate timely implementation of appropriate interventions for identified customer populations following established policies and procedures.
Monitor, support, and engage both staff and additional management in related systemic opportunities, strengths, and benchmarks that will enhance negotiations with payers, improve care management, and/or address gaps in care.
Using accessible data from multiple sources to ensure appropriate outreach, education, and necessary interventions are identified.
Participation in the hiring/firing process of staff across care management.
Engage with direct reports on a monthly basis via monthly individual supervision and larger team meetings to provide timely departmental updates, training, and coaching.
Provide information on staff productivity on a monthly basis, at minimum.
Shadow each direct report at least once per evaluation period unless concerns are identified and more is required.
Conduct one-on-one training and group training with team members for identified areas of need related to workflow, documentation, and/or patient care.
Complete routine audits (in data management system, MaestroCare/Virtual Health, and recorded calls) for quality, clinical care, understanding of education provided, accuracy of process, and overall experience of any PHMO customers.
Participate in identified PHMO/DukeWELL meetings, and role enhancing trainings that are health system/state/regional/nationally appropriate, etc.
Develop and maintain positive relationships with customers internal and external to Duke Health System.
Maintain small caseload/patient-level responsibilities, following identified workflow and meeting required timeframes for completion of documentation, assessment, medication reconciliation and care planning.

Requirements

What you’ll need

Bachelor's degree in a clinical field such as Nursing, Counseling, Social Work, Therapy, Allied Health, or community health related fields.
3 years of clinical experience required.
Extensive management experience
Care/Case management experience within different settings, e.g. Home Health, Community, Gen. Med
Strategic Planning experience
Must have a current license in at least one of these areas: current or compact RN licensure in the state of North Carolina, current licensure as a licensed clinical social worker by the NC Social Work Certification and Licensure Board, current licensure as a Licensed Professional Counselor by the state of NC, or current licensure as a Licensed Addiction Specialist by the state of North Carolina.
Requires ACM or CCM certification within 3 years of hire date or by December 31, 2020.

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off
Flexible work arrangements
Professional development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data managementcare managementdocumentationassessmentmedication reconciliationstrategic planningclinical auditsworkflow managementtrainingnegotiation

Soft Skills

leadershipcommunicationcoachingrelationship buildingteam collaborationproblem-solvingengagementsupervisionorganizational skillstime management

Certifications

RN licensureLicensed Clinical Social WorkerLicensed Professional CounselorLicensed Addiction SpecialistACM certificationCCM certification