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Duke University Hospital is consistently rated as one of the best in the United States and is known around the world for its outstanding care and groundbreaking research. Duke University Hospital has 957 inpatient beds and offers comprehensive diagnostic and therapeutic facilities, including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an Ambulatory Surgery Center with nine operating rooms and an extensive diagnostic and interventional radiology area. In fiscal year 2018, Duke University Hospital admitted 42,916 patients and had 1,085,740 outpatient visits in fiscal year 2017.

U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19.

Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.

In addition to its hospitals, Duke Health has an extensive, geographically dispersed network of outpatient facilities that include primary care offices, urgent care centers, multi-specialty clinics and outpatient surgery centers.

Occ Summary

In conjunction with the Departmental Director, this position provides daily operational oversight, management & leadership for Patient Resource Managers whose activities are associated with the continuum of care, clinical cost reduction, quality & performance improvement, reimbursement & discharge planning. Ensures efficient & professional services designed to meet the needs of the patients, personnel, medical staff & student s and hospital& health system strategic objectives. Requires extensive knowledge of the continuum & reimbursement structures. Position requires data analysis, presentations, collaboration with all other disciplines & development of educational programs for hospital & physician staffs.

Work Performed

• Provide direct line supervision for group of 25-35 highly self-directed professional clinical staff.
• Provide direct line supervision for clerical staff.
• Participate in leadership activities such as committees, conferences, publishing, teaching &research
• Serve as a resource to professional colleagues regarding all areas of responsibility
• Serve as a role model & respond positively to change while supporting colleagues through the process
• Delegate responsibilities to appropriate staff
• Work with Director to establish departmental direction consistent with hospital & health system objectives and re-evaluate annually
• Hire and maintain appropriate staffing ratios consistent with the needs of the organization and within budgetary parameters
• Provide administrative direction to staff
• Provide ongoing education to staff
• Establish and maintains partnership relationship with Duke medical staff and faculty, working collaboratively to achieve hospital, medical staff and health system objectives
• Work collaboratively with all hospital disciplines and CSUs and supports CSU initiatives.
• Establish rapport and work closely with third party payers and community agencies to establish procedures to ensure smooth transition of patients through the health care system and ensure excellent customer service
• Work well with and involves employees to prepare departmental plans
• Keep Director updated and informed of departmental activities and prepares report s and presentations as requested
• Work with the Director to ensure the department is meeting JCAHO and other regulatory body standards
• Conduct on going quality and performance evaluations of new and existing programs and conducts staff PPS on time
• Prepare papers, articles and presentations of department activities
• Assist Director with evaluating effectiveness of PRM program including oversight of annual Physician Satisfaction Survey Process and Reporting, researching industry best practices and operational benchmarks to conduct feasibility studies and make recommendations regarding program design and implementations, and collecting and analyzing data to identify opportunities for program redesign.
• Represent PRM program in absence of Director as assigned
• Serve as a resource for PRM's regarding third party payers, discharge planning resources, federal/state regulatory requirements.
• Serve as a liaison with Billing & Collections and Patient Access Services regarding denials
• Serve as an internal consultant to PRM's, and others involved in care coordination regarding work process and resource requirements
• Evaluate departmental trends and serves as a resource to staff in evaluating service specific trends
• Maintain knowledge of external regulatory requirements and regulations to ensure compliance in program design.
• Examples include JCAHO, Balanced Budget Act, licensure/practice parameters for various disciplines represented by the Patient Resource Management Program, Medicare/Medicaid regulations.
• Ensure departmental compliance with state and federal regulations regarding third party payers (medical necessity, denials, decertification, hold harmless, etc), EMTALA, PATH, BBA, Medicare/Medicaid rulings and initiatives and maintains system for communication LMRP to PRM's.
• Treat all co-workers with dignity and respect
• Allow for diverse opinions, experiences, backgrounds and cultural styles
• Create an environment of openness, trust and acceptance
• Strictly adhere to Duke's EEO/AA philosophy and goals
• Work cooperatively with other c o-workers to accomplish goals
• Develop positive and productive relationships with others
• Serve as a patient advocate

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 with Master's Degree in Healthcare-related field.

Experience

Minimum of 5 years of Acute Care Case Management/Utilization Management experience.At least 2 years of those years must be in a management role.

Degrees, Licensures, Certifications

Must have current or compact RN licensure in the state of North Carolina. Requires certification as a Case Manager or Accredited Case Manager or by December 31, 2017 for current staff. InterQual Certified Instructor preferred, or obtained w/in 1 year of hire.

Job Code: 00005567 DIR, UTILIZATION MANAGEMENT, DUHS
Job Level: I2

Duke is an Affirmative Action/Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.

Duke aspires to create a community built on collaboration, innovation, creativity, and belonging. Our collective success depends on the robust exchange of ideas—an exchange that is best when the rich diversity of our perspectives, backgrounds, and experiences flourishes. To achieve this exchange, it is essential that all members of the community feel secure and welcome, that the contributions of all individuals are respected, and that all voices are heard. All members of our community have a responsibility to uphold these values.

Essential Physical Job Functions: Certain jobs at Duke University and Duke University Health System may include essential job functions that require specific physical and/or mental abilities. Additional information and provision for requests for reasonable accommodation will be provided by each hiring department.