CASE MANAGER - Weekdays - scheduled as needed, Duke Regional Hospital

  • Requisition Number: 401355641
  • Department: DUKE REGIONAL HOSPITAL
  • Location: Durham
  • Type of Position: Regular
  • Shift: First/Day
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Occupational 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 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 and report 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

Level Characteristics

N/A