Case Manager - (US-NC-Durham - 27722)

Minimum Education: None
Job Type: Full Time
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Responsibilities : Responsible for coordinating continuum of care activities for assignedpatients and ensuringoptimum utilization of resources, service delivery and compliance withexternal reviewagencies' requirements.Work PerformedCoordinate 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 andutilization 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 andapplicable federal, state and local regulations; identify benefits,implications and limitations ofhome 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 AbilitiesAbility to work effectively in a self-directed roleAbility tomulti-task, capable of daily problem-solving complexissuesExcellent written and verbal skills.

Requirements :Bachelor's degree from accredited program in a health related field required. Experienceof three years recent acute clinical practice or related health care experience preferred Degrees, Licensures, CertificationsProfessional licensure or registration in a clinical field required. BLS certification required.

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