Population Health Care Manager Complex Case Management

About the Role

Duke Connected Care is a community‑based, physician‑led network that includes a group of doctors, hospitals, and other healthcare providers working together to deliver high‑quality care to Medicare Fee‑for‑Service patients in Durham and surrounding areas. This position is responsible for Complex Care patients in a variety of areas at Duke University Hospital and manages a designated caseload to coordinate and complete timely assessment, planning, implementation, and evaluation of discharge plans and care transitions across the continuum of care. The role ensures optimum utilization of patient and health‑system resources while complying with CMS and other external review agency requirements.

Responsibilities

• Monitor daily census and assignments to assure all patients are assessed.
• Perform related duties incidental to the work described herein.
• Provide case management services including care coordination/transition, discharge planning, consultations, advocacy, and education.
• Maintain effective communication with health‑care team members regarding assessment findings, discharge planning needs, and provider orders for 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, reimbursement guidelines, the discharge planning process, and applicable federal, state, and local regulations; educate providers, patients, and families as needed.
• Collaborate with Utilization Management partners to provide information and feedback that enhances negotiations and denial prevention with payers.
• Document assessment findings, discharge arrangements, and actions taken in a timely manner according to departmental guidelines; prepare reports and maintain records as required.
• Participate in Quality Assurance/Performance Improvement (QAPI) activities as requested.
• Cover site‑specific duties, including weekend, holiday, or after‑hours coverage as designated.
• Develop and maintain positive working relationships with internal and external customers of Duke Health System.

Minimum Qualifications

• Education: BSN or MSW required.
• Experience: Minimum 3 years of relevant experience; Hospital Case Management experience preferred.
• Licensure/Certifications: Current or compact RN licensure in North Carolina (required for BSN candidates). Must obtain a Case Management Certification (ACM, CCM, or ANCC) within two years of hire.

Knowledge, Skills and Abilities

• Ability to work effectively in a self‑directed role.
• Ability to multi‑task and solve complex daily problems.
• Excellent written and verbal communication skills.
• Basic computer skills necessary for documentation and reporting.

Physical Job Functions

Certain positions at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provisions for requests for reasonable accommodation will be provided by the hiring department.