CASE MANAGER - Gen Med Psych

  • Requisition Number: 401549746
  • Department: DUKE HOSPITAL
  • Location: Durham
  • Type of Position: Regular
  • Shift: Rotating
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Occupational Summary

Responsible for coordinating continuum of care activities for assignedpatients and ensuring optimum utilization of resources, servicedelivery and compliance with external review agencies' requirements.

Work Performed

Coordinate and facilitate timely implementation of discharge plans forassigned patients; arrange follow-up care as appropriate.Maintaineffective communication with health care team members related todischarge planning and utilization management.Documentfindings, discharge arrangements and actions taken according todepartmental guidelines; prepare reports and maintain records asrequired.Act as an educational resource and provideconsultation to hospital medical personnel regarding discharge planningprocess and applicable federal, state and local regulations; identifybenefits, implications and limitations of home care as appropriate.Provide concurrent review and follow up with appropriatepersonnel regarding denials.Collect denial data fortrendingWork with appropriate staff to develop processes toprevent denials and improve reimbursement.Collect analyze andreport data for resource utilization, compliance, QI and other areas asassigned.Provide feedback that will enhance negotiations withpayers.Develop and maintain positive relationships withcustomers internal and external to Duke Health System.Performother related duties incidental to the work described herein.

Knowledge Skills and Abilities

Ability to work effectively in a self-directed roleAbility tomulti-task, capable of daily problem-solving complexissuesExcellent written and verbal skillsBasic computer skillsnecessary

Level Characteristics

N/A