CASE MANAGER - Pediatrics

  • Requisition Number: 401498392
  • Department: DUKE HOSPITAL
  • Location: Durham
  • Type of Position: Regular
  • Shift: Rotating
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Occ Summary 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. Work Performed Coordinate and facilitate timely implementation of discharge plans for required. assigned. Perform Maintain other related dutiesincidental to the work described herein. assigned patients; arrange follow-up care as appropriate. 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 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 and report data for resource utilization, compliance, QI and other areas as Provide feedback that will enhance negotiations with payers. Develop and maintain positive relationships with customers internal and external to Duke Health System. Knowledge, Skills and Abilities Ability to work effectively in a self-directed role necessary issues Ability to multi-task, capable of daily problem-solving complex Excellent written and verbal skills Basic computer skills Level Characteristics N/A