Manager, Case Management

Duke Careers•Durham, NC

About The Position

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 University Hospital Pursue your passion for caring with Duke University Hospital in Durham, North Carolina, which is consistently ranked among the best in the United States. The largest of the four Duke Healthhospitals with 1062 patient beds, it features comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center, an endo-surgery center, and more.The Manager reports directly to the Assistant Director of the Case Management Department and provides direct supervision and oversight of the Case Managers (CMs) and Clinical Social Workers (CSWs ) who function within the inpatient and outpatient settings. The Manager is responsible for operationalizing Case Management and Clinical Social Work workflow standards and processes, ensuring adherence to regulatory guidelines and ensuring operations are consistent with DUHS organizational standards.

Requirements

Experience withcare coordination, discharge planning, clinical information documentation and Utilization review.
PC proficiency and experience with care management workflow systems, such as Canopy Knowledge of InterQual criteria and patient status change Strong communication and leadership skills Knowledgeable of JCAHO, federal and state standards/regulations.
Considerable knowledge of large-scale health care facilities, policies, and issues.
Considerable knowledge of clinical protocols and practice management requirements in assigned area.
Ability to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency,
Ability to interpret established policies into operating procedures and to execute case management programs.
Ability to coordinate effectively various functions and activities for maximum cooperation and efficiency
Ability to direct, instruct and advise staff in the approved methods, procedures and practices employed in effective health care administration
Ability to receive and effectively react to day-to-day problems presented by staff as well as others Knowledge of accreditation standards, health care regulations, performance improvement, patient safety and policy formulation.
Effective organizational, oral and written communication skills, problem solving, program development, computer skills, strong leadership, and team building skills.
Ability to work with a variety of disciplines and levels of staff across departments and the health system is required.
Knowledge of payer requirements and discharge planning regulations that support the effect development of departmental policies, procedures and standards Ability to establish priorities, meet deadlines, develop and manage the department's productivity standard in the management of the work assignment
Ability to form positive, collaborative relationships with members of the executive team, hospital staff, post-acute providers and payers
Ability to effectively negotiate with internal and external service providers Knowledge of information systems to support the evaluation of current capacity as well as future needs
BSN or MSW required
3-5 years of relevant management and Case Management experience
Must 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

Responsibilities

Functions as a departmental subject matter expert.
In conjunction with the Team Leaders, the Manager will assess the daily census assignment ensuring acuity and caseloads are equitable.
Provides hands-on support for critical staffing needs.
Monitors productivity.
Partners with CM Director, Assistant Directors and Managers in conducting leadership rounds to support workflow and staff engagement.
Development and oversight of UM work schedules/calendar management via API in accordance with the PTO policy.
Ensure adherence to all Case Management Department and DUHS organizational policies.
Ensures adherence to regulatory compliance.
Promotes an environment of interdepartmental, health system and post- acute care collaboration.
Attends and contributes to the Utilization Management Committee meeting.
Will participate in the development and presentation of projects and education topics to designated departments, provider groups, clinical service units and community collaborators as indicated.
Collaboration with CSU leadership on continuous process improvement
In collaboration with the Directors and Human Resources, manages the recruitment, hiring, onboarding and retention of Case Management Department staff.
Will conduct employee 30/60/90 day evaluations as well as mid-year and end of year evaluations.
In conjunction with the Director, maintains employee Human Resource and secondary files in accordance to Joint Commission and DUHS guidelines.
Ensures compliance with licensure and certification requirements of new and existing employees.
In conjunction with TLs, will support daily patient flow huddles.
Provides education to support regulatory compliance in collaboration with DUHS Compliance and CM Department leadership.
Conducts Utilization Management Divisional Meetings.
Provide education and feedback to provider groups as indicated
Monitors monthly reporting including but not limited to UM productivity, Readmission Documentation, Initial Time to Review, Avoidable Days Documentation, Denials Management and Discharge Appeals processes. Collaborates with the Directors and Team Leads regarding outcomes.
Works with the Physician Advisors and Medical Directors on escalation of care and process improvement activities including but not limited to LOSM, readmissions, avoidable days, denial management, problem solving and education needs.
Participates in the review and updating of Case Management policies.
- Escalates and keeps Directors informed of workflow or personnel concerns.