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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.

Location:

Durham, NC, US, 27710 (Remote)

This position will primarily be remote - work from home with occasional in-office as needed (will include some telephonic communication with patients and providers and regularly scheduled virtual meetings with team members and payers)

Work Hours:
Monday-Friday, general business hours (9a-5p, 8 hour days)

General Description

The Payer Quality Population Health Care Manager demonstrates clinical expertise to address the needs of specific complex and/or rising risk patient populations with a design to meet specific contractual and program related requirements. This role functions as an integral part of an interdisciplinary team, ensuring excellence with quality performance across the continuum. Our goal is to partner closely with payers and providers to ensure we have mutual understanding of the health of our population, as well as the need to focus efforts in certain areas to improve quality outcomes. At PHMO, we are focused on improving the health status and care for all individuals including those with chronic conditions with complex medical, mental health and psychosocial issues. In collaboration with leadership, the team member in this role will identify, plan, and execute activities to promote effective communication with payers and drive quality performance for all patients.

Work Performed

Responsible for understanding the day-to-day work of the payer quality team in order to participate in multiple projects simultaneously. The Payer Quality Population Health Care Manager will help improve processes for medical record reviews, data exchange with payers,information sharing with providers, facilitation of appointment scheduling when needed, and other duties as required.

· Review medical records for presence or absence of listed suspect conditions for attributed patients in partnership with the payers.

· Participate in quality improvement projects as outlined and prioritized by the population health management office.

· Perform chart reviews for the completion of health maintenance screenings and other quality measure completion and evaluate the ability to close quality care gaps for patients.

· Perform outreach to patients as needed to assist with scheduling health maintenance screenings, medical appointments, medication reviews, etc.

· Partner with team members across the system (PRMO, PDC, etc.) on improvement projects related to patient problem lists, HCC/Risk adjustment, updating health maintenance documentation for patients with studies performed outside of Duke, etc.

· Utilize proven processes to measure a patient's understanding and acceptance of the health maintenance plan and his/her willingness and ability to adhere to the plan. Educate patients as needed about the importance of maintaining annual health screenings and partner with other PHMO team members to improve the quality of care we provide.

· Electronically document in Maestro Care as needed, and other documentation systems relevant to the position (payer portal systems, etc.)

· Communicate and coordinate with all provider(s) and member(s) of the care team as needed to minimize fragmented care and foster appropriate utilization of services.

· Assist patients with understanding available access to care, coordinate resources to ensure appropriate utilization, and educate patients on the importance of working closely with their primary care provider.

· Facilitate interdisciplinary communication across PHMO to include internal and external partners to ensure our population's health continues to improve.

· Develop and maintain positive relationships with customers internal and external to Duke Health System.

· Demonstrate the ability to effectively multi-task in a fast-paced environment, managing multiple priorities.

RequiredQualifications at this Leve l

Education

Bachelor's degree in a clinica l field such as Nursing, Counseling, SocialWork, Therapy, Allied Health, or community health related fields.

Experience

3 y ears of clinical experience required.

Education

Bachelor's degree in a clinical field such as Nursing, Counseling, Social Work, Therapy, Allied Health, or community health related fields.

Experience

3 years of clinical experience required.

Degrees, Licensures, Certifications

Must have a current license in at least one of these areas: current or compact RN licensure in the state of North Carolina, current licensure as a licensed clinical social worker by the NC Social Work Certification and Licensure Board, current licensure as a Licensed Professional Counselor by the state of NC, or currentlicensure as a Licensed Addiction Specialist by the state of North Carolina. Requires ACM or CCM certification within 3 years of hire date or by December 31, 2020.

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 essentialjob 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.