Duke University Health System (DUHS) Job Descriptions
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CASE MANAGER
Job Title: CASE MANAGER
Job Code: 5013
FLSA: E
Job Level: G2
Revised Date: 08/30/2021
Supervisory Responsibility: No
General Description of the Job Class
Manage a designated caseload to coordinate and complete timely assessment, planning, implementation and evaluation of discharge plans and care transitions across the continuum of care. Ensure optimum utilization of the patient's and the Health System's resources and perform these duties within the requirements of CMS and other external review agencies.
Duties and Responsibilities of this Level
Monitor daily census and assignment to assure all patients are assessed for case management needs including care coordination/transition and discharge planning, consultations, advocacy, education.
Maintain effective communication with health care team members related to assessment findings, discharge planning needs and provider orders needed to arrange Homecare, Durable Medical Equipment, Transportation, Skilled Nursing or Acute Rehab Facility placement, Substance Abuse Treatment and outpatient follow-up.
Maintain working knowledge of specific benefits and reimbursement guidelines, the discharge planning process and applicable federal, state and local regulations. Provide education and guidance on these topics to providers, patients and families as needed.
Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers.
Maintain timely documentation of assessment findings, discharge arrangements and actions taken according to departmental guidelines; prepare reports and maintain records as requested and/or required.
Participate in Quality Assurance/Performance Improvement (QAPI) activities as requested.
Job responsibilities may include site specific duties, weekend/holiday or after hours coverage as designated at each entity.
Develop and maintain positive working relationships with customers internal and external to Duke Health System.
Perform other related duties incidental to the work described herein.
Required Qualifications at this Level
Education
BSN or MSW required
Experience
3 years of relevant experience
Degrees, Licensure, and/or Certification
Requires Case Management Certification (ACM, CCM or ANCC) within 3 years of hire.
BSN required and must have current or compact RN licensure in state of NC.
or
MSW(if no BSN or compact RN licensure in NC)
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
Distinguishing Characteristics of this Level
N/A
The intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform job-related tasks other than those specifically presented in this description.
Duke University 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.
