Population Health Care Manager-Payers Quality PAF's Remote

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.

External Candidates eligible for a $10,000.00 Commitment Bonus paid over 2 years

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 s pecific contractual and program related requirements. This role function s as an integral part of an interdisciplinary team, ensuring excellence with quality performance across the continuum. Our goal is to partner cl osely with payers and providers to ensure we have mutual understanding o f 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 im proving the health status and care for all individuals including those w ith chronic conditions with complexmedical, mental health and psychosoc ial issues. In collaboration with leadership, the team member in this role will identify, plan, and execute activities to promote effecti ve communication with payers and drive quality performance for all patients.  

Work Performed

Responsible for underst anding the day-to-day work of the payer quality team in order to partici pate in multiple projects simultaneously. The Payer Quality Population H ealth Care Manager will help improve processes for medical record review s, data exchange with payers, information sharing with providers, facili tation of appointment scheduling when needed, and other duties as requir ed.

• Review medical records for presenc e or absence of listed suspect conditions for attributed patients i n partnership with the payers.
• Participate in qua lity improvement projects as outlined and prioritized by the popula tion health management office.
• Perform chart reviews for the completion of health maintenance screenings and ot her quality measure completion and evaluate the ability to close qu ality care gaps for patients.

• P erform outreach to patients as needed to assist with scheduling hea lth maintenance screenings, medical appointments, medication review s, etc.
• Partner with team members across the system (PRMO, PDC, etc.) on improvement projects related to patien t problem lists, HCC/Risk adjustment, updating health maintenance d ocumentation 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 pati ents as needed about the importanceof maintaining annual health sc reenings and partner with other PHMO team members to improve the quality of care we provide.

• Electronic ally document in Maestro Care as needed, and other documentation sy stems relevant to the position (payer portal systems, etc.)< /li>
• Communicate and coordinate with all provider(s) and member(s) of the care team as needed to minimize fragmented care a nd foster appropriate utilization of services. 
• A ssist patients with understanding available access to care, coordin ate resources to ensure appropriate utilization, and educate patien ts on the importance of working closely with their primary care pro vider.

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

• Develop and maintain positive relationshi ps with customers internal and external to Duke Health System.
• Demonstrate the ability to effectively multi-task in a fast-paced environment, managing multiple priorities.

Bachelor's degree in Nursing or Master's degree that supports licensure by the NC Board of Licensed Clinical Mental Health Counselors (i.e., counseling, social work, allied/behavioralhealth).

3 years of relevant clinical experience required.

Candidates with a BSN must have current or compact RN licensure in state of NC Candidates with a Master's degree (e.g., psychology, social work, counseling, or related behavioral health program) must have a current licensure by one of the following NC Boards: Licensed Clinical Social Worker (LCSW), Licensed Clinical Addiction Specialist (LCAS), or Licensed Clinical Mental Health Counselor (LCMHC) AND All candidate/employees require a case management certification (ACM, CCM, or ANCC) within 3 years of hire

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.

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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.