Case Manager

Case Manager

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 for 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.

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.

Perform other related duties incidental to the work described herein.

Required Qualifications at this Level:

Education: BSN or MSW required

Experience: 3 years of relevant experience

Degrees, Licensure, and/or Certification: Requires Case Management Certification (ACM, CCM or ANCC) within 3 years of hire. BSN required and must have current or compact RN licensure in state of NC. or MSW (if no BSN or compact RN licensure in NC)

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

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.