Medical Case Manager

Company: Duke Health
Location: Durham
Posted on: September 21, 2023

Job Description:

Duke Regional Hospital Duke Regional Hospital offers the personal touch and hometown feel of a community hospital while serving as an essential arm of internationally recognized Duke University Health System. Duke Regional has served Durham, Orange, Person, Granville and Alamance counties for more than 45 years. To be successful at caring for our community and have a strong reputation among patients who seek our care, we have 3,500 team members who work together to provide exceptional, compassionate and equitable healthcare 24/7. We are a place of learning and acceptance for team members just starting their careers, as well as an institution of family culture and professional development for employees who have served for decades in our hospital units.Duke Regional has 388 inpatient beds and offers a comprehensive range of medical, surgical and diagnostic services, including orthopedics, weight-loss surgery, women's services, and heart and vascular services. We also offer care at our Duke Rehabilitation Institute, Davis Ambulatory Surgical Center, Duke Ambulatory Surgery Center Arringdon, Health Services Center, and Duke Behavioral Health Center North Durham. In fiscal year 2021, Duke Regional Hospital admitted 16,422 patients, performed 18,152 surgeries and welcomed 2,673 babies into the world. U.S. News & World Report ranked Duke Regional Hospital as #9 in North Carolina and #4 in the Raleigh-Durham area for 2021-22. The Human Rights Campaign consistently names us a Healthcare Equality Leader, and we are a Joint Commission-accredited and Magnet-designated hospital.The Manager reports directly to the Assistant Director of the Case Management Department and provides direct supervision and oversight of the Case Managers (CMs) and Clinical Social Workers (CSWs ) who function within the inpatient and outpatient settings. The Manager is responsible for operationalizing Case Management and Clinical Social Work workflow standards and processes, ensuring adherence to regulatory guidelines and ensuring operations are consistent with DUHS organizational standards. -Work Performed -

• Functions as a departmental subject matter expert.
• In conjunction with the Team Leaders, the Manager will assess the daily census assignment ensuring acuity and caseloads are equitable.
• Provides hands-on support for critical staffing needs.
• Monitors productivity.
• Partners with CM Director, Assistant Directors and Managers in conducting leadership rounds to support workflow and staff engagement.
• Development and oversight of UM work schedules/calendar management via API in accordance with the PTO policy.
• Ensure adherence to all Case Management Department and DUHS organizational policies.
• Ensures adherence to regulatory compliance.
• Promotes an environment of interdepartmental, health system and post- acute care collaboration.
• -Attends and contributes to the Utilization Management Committee meeting.
• Will participate in the development and presentation of projects and education topics to designated departments, provider groups, clinical service units and community collaborators as indicated.
• Collaboration with CSU leadership on continuous process improvement
• In collaboration with the Directors and Human Resources, manages the recruitment, hiring, onboarding and retention of Case Management Department staff.
• Will conduct employee 30/60/90 day evaluations as well as mid-year and end of year evaluations.
• In conjunction with the Director, maintains employee Human Resource and secondary files in accordance to Joint Commission and DUHS guidelines.
• Ensures compliance with licensure and certification requirements of new and existing employees.
• In conjunction with TLs, will support daily patient flow huddles.
• Provides education to support regulatory compliance in collaboration with DUHS Compliance and CM Department leadership.
• Conducts Utilization Management Divisional Meetings.
• Provide education and feedback to provider groups as indicated
• Monitors monthly reporting including but not limited to UM productivity, Readmission Documentation, Initial Time to Review, Avoidable Days Documentation, Denials Management and Discharge Appeals processes. Collaborates with the Directors and Team Leads regarding outcomes.
• Works with the Physician Advisors and Medical Directors on escalation of care and process improvement activities including but not limited to LOSM, readmissions, avoidable days, denial management, problem solving and education needs.
• Participates in the review and updating of Case Management policies. - Escalates and keeps Directors informed of workflow or personnel concerns. -Knowledge, Skills and Abilities -Experience withcare coordination, discharge planning, clinical information documentation and Utilization review.PC proficiency and experience with care management workflow systems, such as Canopy Knowledge of InterQual criteria and patient status change Strong communication and leadership skills Knowledgeable of JCAHO, federal and state standards/regulations.Considerable knowledge of large-scale health care facilities, policies, and issues.Considerable knowledge of clinical protocols and practice management requirements in assigned area.Ability to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency, Ability to interpret established policies into operating procedures and to execute case management programs.Ability to coordinate effectively various functions and activities for maximum cooperation and efficiency Ability to direct, instruct and advise staff in the approved methods, procedures and practices employed in effective health care administration Ability to receive and effectively react to day-to-day problems presented by staff as well as others Knowledge of accreditation standards, health care regulations, performance improvement, patient safety and policy formulation.Effective organizational, oral and written communication skills, problem solving, program development, computer skills, strong leadership, and team building skills. Ability to work with a variety of disciplines and levels of staff across departments and the health system is required.Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards Ability to establish priorities, meet deadlines, develop and manage the department's productivity standard in the management of the work assignment Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers and payers Ability to effectively negotiate with internal and external service providers Knowledge of information systems to support the evaluation of current capacity as well as future needs -Education -BSN or MSW required -Experience3-5 years of relevant management and Case Management experience - -Degrees,Licensure, and/or CertificationMust have current or compact RN licensure in the state of North Carolina or current licensure as a licensed clinical social worker by the NC Social Work Certification and Licensure BoardJob Code: 00005306 MANAGER, CASE MANAGEMENT
  Job Level: I1 -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. -

Keywords: Duke Health, Durham , Medical Case Manager, Executive , Durham, North Carolina