Case Manager

4 weeks ago

Durham, North Carolina, United States Duke Health Full time
Case Manager Job Summary

At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. Our team of dedicated professionals is passionate about delivering exceptional patient care and making a meaningful difference in the lives of those we serve.

About Duke Regional Hospital

Duke Regional Hospital is a comprehensive healthcare facility that offers a wide range of medical, surgical, and diagnostic services. Our hospital is committed to providing high-quality patient care and is recognized for its excellence in various specialties, including orthopedics, weight-loss surgery, women's services, and heart and vascular services.

Duke Nursing Highlights:

  • Duke University Health System is designated as a Magnet organization, recognizing our commitment to nursing excellence and patient care.
  • Nurses from each hospital are consistently recognized as North Carolina's Great 100 Nurses, demonstrating our dedication to providing exceptional patient care.
  • Duke University Health System was awarded the American Board of Nursing Specialties Award for Nursing Certification Advocacy, highlighting our commitment to nursing certification and professional development.
  • Duke University Health System has registered nurses who are dedicated to providing high-quality patient care and are recognized for their expertise in various specialties.
  • Quality of Life: Living in the Triangle
  • Relocation Assistance (based on eligibility)

Job Responsibilities:

  • 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.
  • 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 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.

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.

Minimum Qualifications:

Education:

BSN or MSW required.

Experience:

3 years of relevant experience.

Degrees, Licensures, Certifications:

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.

Duke is an Affirmative Action/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, sexual orientation, or veteran 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.

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