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Case Manager
2 months ago
As a Case Manager at Duke Health, you will play a vital role in coordinating and completing timely assessments, planning, implementation, and evaluation of discharge plans and care transitions across the continuum of care. Your primary responsibility will be to ensure optimum utilization of the patient's and the Health System's resources, all while performing duties within the requirements of CMS and other external review agencies.
Key Responsibilities- Monitor daily census and assignment to ensure 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 healthcare 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.
- 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.
BSN or MSW required.
3 years of relevant experience.
Requires Case Management Certification (ACM, CCM, or ANCC) within 3 years of hire.
MSW or BSN required. If BSN, must have current or compact RN licensure in the state of NC.
