Responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery and compliance with external review agencies' requirements.
Coordinate and facilitate timely implementation of discharge plans for assigned patients; arrange follow-up care as appropriate. Maintain effective communication with health care team members related to discharge planning and utilization management. Document findings, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as required.Act as an educational resource and provide consultation to hospital medical personnel regarding discharge planning process and applicable federal, state and local regulations; identify benefits, implications and limitations of home care as appropriate.Provide concurrent review and follow up with appropriate personnel regarding denials.Collect denial data for trending Work with appropriate staff to develop processes to prevent denials and improve reimbursement.Collect analyze andreport data for resource utilization, compliance, QI and other areas as assigned. Provide feedback that will enhance negotiations with payers.Develop and maintain positive relationships with customers internal and external to Duke Health System. Perform other related duties incidental to the work described herein.
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
Requisition Number: 401513177
Duke Entity: DUKE HOSPITAL
Job Code: 5013 CASE MANAGER
Job Family Level: G1
Full Time / Part Time: FULL TIME
Regular / Temporary: Regular
Duke University 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.
BSN or MSW required
3 years of relevant experience
Degrees, Licensures, Certifications
Requires ACM or CCM certification within 3 years of hire or by December31, 2017 for current employee. BSN must have current or compact RNlicensure in the state of North Carolina. MSW must have a current NorthCarolina license as a CMSW within 90 days of hire or a current licenseas an LCSW.
Auto req: ID106416BR