Care Coordinator

• Function as part of a multidisciplinary team including physicians, social workers, discharge planning assistants, and payers
• Ensure patients progress through acute care and post-discharge care in a quality-driven, efficient, cost-effective, and safe manner
• Facilitate effective and efficient transitions through hospitalization with attending and consulting physicians
• Coordinate care delivery across the continuum and ensure patient needs are met and resources are appropriately utilized
• Develop complex patient transition and discharge plans with social workers
• Interact with patients, families, healthcare professionals, community agencies, and state agencies
• Serve as an advanced clinical resource and liaison between the hospital and community agencies or facilities
• Maintain hospital compliance with QIO series and CMS guidelines
• Use medical necessity criteria to assess level and setting of care
• Assist with denial and appeals processes; assess quality and report potential risk-management issues
• Participate in and complete patient-safety initiatives
• Establish and maintain professional rapport with providers, patients/families, and internal customers

Care Coordinator, RN – Acute Care Pediatrics

• Manage the member’s experience from completed trip intake through transportation completion
• Monitor trips, perform trip recovery and templating, solve problems, and update customer notes
• Make outbound calls to members, providers, and facilities to confirm, correct, or verify trip information
• Provide member education and ensure successful trip outcomes
• Liaise with health plan clients, members, and internal/external partners
• Provide support to client- or stakeholder-identified populations
• Confirm and verify transportation, ensure trip accuracy, and mitigate emergency trips during disasters
• Maintain an impacted member list and follow up to ensure safe, timely appointment transportation
• Document escalations, action plans, complaints, grievances, and care coordination services in intake systems
• Process escalated trips promptly to prevent complaints or member service failures
• Report unusual trip circumstances and vendor-operation inefficiencies to leadership
• Maintain working knowledge of MTM technology, portals, applications, and NEMT services
• Ensure compliance with KPIs, contract requirements, policies, procedures, training, and monthly development sessions
• Set reservations for select managed facilities and members
• Perform other duties as assigned

Care Coordinator jobs in Virginia

Care Coordinator, RN – Acute Care Pediatrics

Regional Care Coordinator