Population Health Care Manager- Team Lead

Duke Connected Care, a community-based, physician-led network, includes a group of doctors, hospitals and other healthcare providers who work together to deliver high-quality care to Medicare Fee-for-Service patients in Durham and itssurrounding areas.

 

DukeWELL Team Lead Functional Job Description

 

The Team Lead oversees a team of 6-12 team members working in-office, hybrid, or fully remote within the PHMO. As a member of the PHMO leadership team, the Team Lead collaborates with other PHMO leadership team members to ensure team goals and responsibilities are effectively achieved. In partnership with PHMO managers, directors, and senior leadership, the Team Lead identifies, plans, and implements activities that drive best-in-class performance aligned the PHMO roadmap, while ensuring compliance with PHMO and DUHS policies and procedures. Additionally, this role may engage with DUHS entity leadership, including direct care teams across multiple sites, to engage, foster, and maintain strong PHMO relationships through consistent and effective communication and collaboration.

The Team Lead is essential in driving operational excellence, fostering team development and change management, and ensuring high-quality care and service delivery within PHMO.

 

General Description of the Job Class

 

The Team Lead assumes additional responsibilities beyond their primary job classification, providing operational oversight and functional expertise in their designated area within PHMO. This role ensures team efficiency, compliance with program and contractual requirements, and alignment with PHMO goals. Areas of focus may include specific populations, quality assurance and improvement, engagement and referral processes, clinical conditions, education and training, and filling in for frontline team members as needed.

In addition, the Team Lead is responsible for program development, continuous process improvement, and effective communication with PHMO leadership and other relevant entity leaders. As a key member of an interdisciplinary team, the Team Lead plays a critical role in enhancing whole-person care, quality outcomes, and care transitions.

Duties and Responsibilities of this Level

• Project Coordination & Outcome Tracking: Monitors and coordinates team-specific projects, collaborates with PHMO colleagues, and tracks outcomes with support from the data team.
• Intervention Implementation: Ensures timely implementation of appropriate interventions for identified populations following established policies and procedures, and recommends improvements when gaps are identified.
• Performance Enhancing and Benchmarking: Supports team members in identifying systemic opportunities, strengths, and performance benchmarks to improve payer relations, care management, care transitions, and gap closure. Uses data from multiple sources for targeted outreach, education, and intervention strategies.
• Employee Engagement & Oversight: Conducts monthly individual team member and team meetings to provide updates, training, coaching, and recognition. Engages with individual team members at least monthly to review and discuss performance related to the relevant EJR and team outcomes.
• Observation & Training: Shadows each direct report at least once per evaluation period, or more frequently if concerns arise. Conducts individual and group training to address workflow, documentation, and patient care needs. Is an integral and active participant in onboarding and training new team members.
• Time & Attendance Management: Manages team member time and attendance within the API system.
• Quality Assurance & Auditing: Performs routine team member audits within relevant systems (e.g., data management system, electronic health record (EHR), and recorded calls) to assess quality, clinical care, education accuracy and appropriateness, process adherence, and customer experience. Provides timely feedback and oversight.
• Organizational Engagement: Attends and actively participates in identified PHMO/DukeWELL meetings, training sessions, and initiatives.
• Relationship Management: Develops and maintains strong relationships with internal and external stakeholders and customers across Duke Health.  

 

General Description of the Job Class

The Population Health Care Manager is responsible for delivering clinical expertise to manage health care needs of specific patient populations across the continuum of care with a goal of improving patient health outcomes and reducing unnecessary utilization and cost