Director Case Management
Company: Duke Health
Location: Durham
Posted on: April 25, 2024
Job Description:
At Duke Health, we're driven by a commitment to compassionate
care that changes the lives of patients, their loved ones, and the
greater community. No matter where your talents lie, join us and
discover how we can advance health together. -About Duke Regional
Hospital -Pursue your passion for caring with Duke Regional
Hospital in Durham, North Carolina, which ranks as the number four
hospital in the Raleigh-Durham, North Carolina area, accordingto
U.S. News and World Report for 2023-2024. Duke Regional Hospital is
the second largest of Duke Health's three hospitals and offers a
comprehensive range of medical, surgical, and diagnostic services,
including orthopedics, weight-loss surgery, women's services, and
heart and vascular services.Duke Nursing Highlights: -
- Duke University Health System is designated as a Magnet
organization
- Nurses from each hospital are consistentlyrecognized each year
as North Carolina's Great 100 Nurses.
- Duke University Health System was awarded the American Board of
Nursing Specialties Award for Nursing Certification Advocacy for
being strong advocates of specialty nursing certification.
- Duke University Health System has 6000 + registered nurses
- Quality of Life: Living in the Triangle!
- Relocation Assistance (based on eligibility) -Occ SummaryIn
conjunction with the Health System AVP for Care Coordination, this
position provides daily operational oversight, management and
leadership for staff of the Case Management Department whose
activities are associated with the continuum of care, clinical cost
reduction, utilization management, care transitions, population
management, quality, performance improvement, reimbursement and
discharge planning. Ensures efficient and professional services
designed to meet the needs of the patients, personnel, medical
staff, students, hospital and health system strategic objectives.
Requires extensive knowledge of the continuum, conditions of
participation and reimbursement structures. Position requires data
analysis, presentations, collaboration with all other disciplines
and development of educational programs for hospital and physician
staff.
-Work Performed
- Provide direct line supervision of an assigned group of
professional department. direction. clinical staff and oversight of
clerical staff.
- Delegate responsibilities as appropriate, providing
administrative and clinical
- Provide clinical supervision for provisionally licensed staff,
meeting both requirements of the Department and NC Certification
and Licensure Board.
- On an annual basis, develop measurable, reasonable and
market-oriented goals for the department that reflect those of the
hospital, health system and the department.
- Ensure that the Utilization Management and the Discharge
Planning process are current.
- Establish policies, procedures and protocols for departmental
functions.
- Create processes to anticipate and address specific situations
within the department, including long stay patients, post-acute
resource referral lists, denials, and termination of benefits.
Identify improvement opportunities within the department and at the
system level and create strategies to address them.
- Establish and maintain relationships with medical staff and
faculty both internally and externally, working collaboratively to
achieve hospital, medical staff and health system objectives.
Develop structures and processes to facilitate participation by
physicians, pharmacists, nurses, Social Workers and other health
professionals in multidisciplinary care planning, care delivery,
utilization review and discharge planning.
- Assist AVP with evaluating effectiveness of case management
program, researching industry best practices and operational
benchmarks to conduct feasibility studies and make recommendations
regarding program design and implementation.
- Collect and analyze data to identify opportunities for program
redesign and performance improvement.
- Updates and informs AVP of departmental activities and prepares
reports and presentations as requested.
- Participate in leadership activities such as committees,
conferences, publishing, teaching and research, serving as a
resource to professional colleagues regarding all areas of
responsibility.
- Hire and maintain appropriate staffing ratios consistent with
the needs of the organization and within budgetary parameters, as
well as, participate in the development and administration of the
budget for the
- Provide orientation and ongoing education to staff.
- Evaluate and optimize patient satisfaction.
- Resolve conflicts related to discharge planning with
patients/families, external agencies and payers.
- Collaborate with third party payers and community agencies to
establish procedures to ensure smooth transition of patients
through the continuum of care and ensure excellent customer
service.
- Serve as a liaison with Billing and Collections and Patient
Access Services regarding denials.
- Direct utilization review activities for the hospital,
interfacing with external payers and review companies to determine
appropriate medical necessity of admissions and continued
hospitalization.
- Work with the AVP to ensure the department is meeting
regulatory body standards.
- Conducts staff performance evaluations.
- Engages, empowers and involves employees to departmental goals
and work culture initiatives.
- Support organizational values and serve as a role model;
responding positively to change while supporting colleagues through
the process.
-Knowledge, Skills and AbilitiesComputer skills including word
processing, spreadsheets and relational databases desired. Must
possess excellent written and verbal communication skills,
interpersonal & team building skills.
-Level CharacteristicsN/A
-Minimum Qualifications -EducationBSN or MSW required; Masters
degree in a healthcare field
-ExperienceMinimum of 5 years of related experience required. At
least 2 of the years of related experience must be in a management
role.
-Degrees, Licensures, CertificationsMust 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 Board. Requires certification as a Case Manager or
Accredited Case Manager or by May, 2027. -DIR, CASE MANAGEMENT
Job Level: J2 -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, Chapel Hill , Director Case Management, Executive , Durham, North Carolina
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