Director Case Management

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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 Summary

In 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 Abilities

Computer skills including word processing, spreadsheets and relational databases desired. Must possess excellent written and verbal communication skills, interpersonal & team building skills.

Level Characteristics

N/A

Minimum Qualifications

Education

BSN or MSW required; Masters degree in a healthcare field

Experience

Minimum of 5 years of related experience required. At least 2 of the years of related experience must be in a management role.

Degrees, Licensures, Certifications

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. Requires certification as a Case Manager or Accredited Case Manager or by May, 2027.

DIR, CASE MANAGEMENT
Job Level: J2

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