Utilization Manager, Manager DUHS

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Duke Nursing Highlights:

 

• Duke University Health System is designated as a Magnet organization
• Nurses from each hospital are consistently recognized 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)

 

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.

 

Work Performed

• 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.

 

Knowledge, Skills and Abilities

• 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 kn