PROGRAM MANAGER - Referral Center - Duke Homecare and Hospice
Duke University Health System
Location: Durham, North Carolina
Internal Number: 171950
Duke Homecare & Hospice offers hospice, home health and infusion services. Hospice care is offered to terminally ill patients in their home, skilled-nursing facilities, assisted-living facilities, and at our two inpatient facilities located in Hillsborough and Durham, North Carolina.
In addition to the responsibilities and requirements described in the Duke job description, the Duke HomeCare & Hospice DHCH Program Manager will be responsible for:
In alignment with the goals and policies of Duke HomeCare & Hospice (DHCH), the Program Manager provides direction for assigned programs and activities specific to DHCH Referral Center operations. Coordinate and participate in strategic planning and operational meetings as appropriate with DHCH leadership and appropriate staff to determine specific objectives of the programs. Also work collaboratively with DHCH Business Development team and DHCH leadership to identify internal and external resources available to meet those objectives. Ensure efficient and effective referral coordination which includes fiscal and operational responsibility. Collaborate and coordinate with Finance, Clinical Leadership, and Care Coordination team.
Referral Center (RC)
ACNO/Senior Director of Clinical Operations
Referral Center-Administrative Clerk, Administrative Assistant, Program Specialist-Verification, Financial Care Counselors-Authorization, Infusion Program Specialist, LPNs
Major Job Responsibilites
1. Actively oversee Home Health, Hospice and Infusion insurance verification and authorization process to ensure timely and accurate information is obtained to ensure the programs receive payment for services rendered.
2. Actively contributes to the project management activities for assigned projects, and holds responsibility and accountability for managing assigned work contributing to the success of the project.
3. Maintain a working knowledge of the Billing Requirements per the Regulatory Guidelines of CMS.
4. Collaborate with PRMO on new health insurance plans and changes. Report trends in patient insurance authorization access issues to DHCH Finance Senior Leadership.
5. Define scope of work requirements for new projects and may be assigned to lead work within an ongoing project.
6. Facilitate, collect data and report out of Tier 1 Huddles.
7. Implement A3 work resulting from Tier 1 Huddles and participate in other A3 projects throughout DHCH related to the RC.
8. Independently proficient within the Intake, Referral, Verification, and Authorization Processes.
9. Ensure cross-training among Team Members to assure operational efficiencies: (i.e.: during planned and unplanned PTO, holidays, and other events).
10. Proficient in understanding the policies and procedures of DHCH as they relate to the RC Department.
11. Proficient in understanding and effectively communicating the information contained in the policy and procedure for Emergency Operations to the RC team.
12. Assure inclement weather planning is clearly communicated to RC team.
13. Analyze and resolve issues that have potential to jeopardize agreed-upon deliverables.
14. Responsible for the achievement of department, service line/and organizational growth goals.
15. Provide routine activity reports to the Senior Director of Clinical Operations.
16. Participate in quality initiatives and ensure timelines and deliverables of the projects are well managed.
17. Identify any needs for modification to standard workflows with the department and collaboratively develop as necessary.
18. Troubleshoot issues across projects, identifying the underlying root causes and improvements for efficiency. Identifies the need for modification to standard work flows within the department and collaboratively develops as necessary.
19. Manage internal and external customer expectations.
20. Perform Service Recovery activity as needed.
21. Identify and ensure compliance with regulations and policies.
22. Supervise the daily operation of the Referral Center and associated team and provides ongoing coaching and professional development of Referral Center staff.
23. Complete Performance Coaching evaluations of the Referral Center and associated teams per policy.
24. Provide ongoing training support to referral center staff regarding ongoing changes with insurance plan contracts and guidelines.
25. Effectively collaborate with Program and Finance to resolve billing concerns to realize financial compensation.
26. Educate the referral source about all DHCH service lines including eligibility criteria, and all elements and support.
27. Collaborate and coordinate with the referral source to ensure that patient needs will be met and outcomes will be achieved to prevent hospitalizations and/or readmissions to the hospital.
28. Perform other related duties incidental to the work described herein.
Preferred Qualifications at this Level
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily and have excellent written and communication skills. The individual must be detail-oriented and possess time management, analytical, and organizational skills. The individual must be an independent and self-motivated worker. The requirements listed below are representative of the knowledge, skill and ability required. Experience with large scale implementation projects preferred.
Education Work requires communications, analytical and organizational skills generally acquired through completion of a bachelor's degree program.
Experience Work requires the ability to plan and administer programs and direct program activities within a specific functional area, generally acquired through four years of related experience.
OR ANY OTHER EQUIVALENT COMBINATION OF RELEVANT EDUCATION AND/OR EXPERIENCE
Professional Work Experience
Degrees, Licensure, and/or Certification N/A
Knowledge, Skills, and Abilities Strong knowledge and experience with healthcare insurance verification and authorization. Strong computer skills, MS Office, Teams.
Distinguishing Characteristics of this Level N/A
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