Care Coordination Specialist

2 weeks ago


Atlanta, Georgia, United States Kaiser Permanente Full time
Job Overview:

The Care Coordination Specialist plays a pivotal role in facilitating non-clinical operations across the care continuum. This position is essential in assisting Case Managers and Physicians with their daily tasks, ensuring that data integrity is maintained for all relevant inpatient and outpatient services. The Specialist is responsible for coordinating data entry, analysis, and reporting related to utilization management, continuing care services, case management, and external service management.

Key Responsibilities:
  • Facilitates non-clinical operations throughout the care continuum.
  • Assists in discharge planning for members across various care settings.
  • Handles incoming calls to address inquiries from patients, vendors, and other healthcare stakeholders, managing a high volume of calls daily.
  • Operates effectively in a call-centric environment, meeting established performance metrics.
  • Maintains productivity to fulfill the needs of members and healthcare providers.
  • Inputs authorization and referral data into necessary systems, ensuring accuracy in admitting, principal, and discharge diagnoses, bed types, discharge dates, and other relevant fields.
  • Reviews and updates authorizations daily to ensure the accuracy of Census Reports, participating in case management rounds to update diagnoses or other pertinent information as required.
  • Documents external medical services and processes referrals in the system for all levels of care.
  • Verifies eligibility and benefits for all admissions and conducts follow-ups every seven days or as designated.
  • Determines admission status based on physician orders for weekend retro admissions, entering authorizations for review.
  • Coordinates data and reporting requirements, overseeing data collection processes and addressing data processing issues, while providing timely utilization data and analytical support.
  • Collaborates with various organizational units and external facilities to obtain, verify, and provide necessary information, including working with claims and vendors to reconcile billed charges.
  • Responds to inquiries and educates members, physicians, and hospitals regarding covered benefits and related topics.
  • Assists members during the claims review process, coordinating both authorized and non-authorized claims reviews.
  • Oversees air and ground transportation coordination and authorization reviews for these services.
  • Manages durable medical equipment coordination for members.
  • Ensures the consistency and integrity of all applicable utilization tracking management systems.
  • Schedules appointments for members and coordinates care as necessary.
  • Determines admission status based on physician orders for weekend retro admissions, entering authorizations and forwarding to case management for review.
  • Processes pended claims in the system, forwarding them to the appropriate staff for investigation and returning them to the claims pool once resolved.
  • Generates, prints, and distributes Census Reports for rounds, attending case rounds with staff and physicians.
  • Copies required sections of member charts for referrals to all levels of care, organizing documentation as requested by Case Managers or Utilization Reviewers.

  • Physical Therapist

    1 day ago


    Atlanta, Georgia, United States Atlanta Hand Specialist Full time

    Job Description**Full-time Hand Therapy Physical Therapist Needed**We are seeking a highly skilled and experienced Physical Therapist to join our team at Atlanta Hand Specialist. As a Hand Therapy Physical Therapist, you will play a critical role in providing high-quality patient care and contributing to the success of our hand surgery practice.Key...


  • Atlanta, Georgia, United States Nurse Care of Buckhead Full time

    Position Overview:As a Clinical Staff Coordination Specialist, you will play a pivotal role in managing and overseeing the operations of the clinical department.Key Responsibilities:Facilitate the coordination of information systems and educational initiatives within the clinical department.Ensure compliance with Board of Nursing standards.Collaborate with...

  • Nurse Care Coordinator

    2 months ago


    Atlanta, Georgia, United States Ennoble Care Full time

    About UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs...


  • Atlanta, Georgia, United States ReNew Wound Care Full time

    Job Opportunity at ReNew Wound CareJob Title: Advanced Wound Care SpecialistJob Summary:We are seeking a highly skilled Advanced Wound Care Specialist to join our team at ReNew Wound Care. As a key member of our team, you will be responsible for providing advanced wound care services to patients in skilled nursing facilities.Responsibilities:Assessment and...


  • Atlanta, Georgia, United States Ace Care Management Full time

    Job OverviewAce Care Management is seeking a dedicated Care Coordination Professional to join our team and contribute to the delivery of high-quality care services to our members.This role involves a combination of direct and indirect care activities, from monitoring communications and records to collaborating with various departments and stakeholders. The...


  • Atlanta, Georgia, United States Emory Health Care Full time

    Job OverviewJoin a team that inspires and rewards you.At Emory Healthcare, we support your professional journey with exceptional benefits, valuable resources, continuous mentorship, and leadership development programs tailored for various roles. Our environment fosters growth, enabling you to achieve your career aspirations.Comprehensive health benefits...


  • Atlanta, Georgia, United States Emory Health Care Full time

    Join Our Team at Emory HealthcareAt Emory Healthcare, we are dedicated to enhancing your professional journey with exceptional benefits, valuable resources, and a supportive atmosphere that fosters your growth and success.What We Offer:- Comprehensive health benefits from day one- Assistance with student loan repayment and reimbursement programs-...


  • Atlanta, Georgia, United States Emory Health Care Full time

    Join Our Team as a Registered Nurse Care CoordinatorAt Emory Healthcare, we are dedicated to fostering a professional environment that inspires and rewards our team members. We offer a range of benefits, resources, and ongoing mentorship to support your career development.What We Offer:Comprehensive health benefits starting on your first dayStudent Loan...


  • Atlanta, Georgia, United States Chenega Corporation Full time

    CHENEGA CORPORATIONEvent Coordination SpecialistThe Event Coordination Specialist at Chenega Corporation is tasked with overseeing the effective execution of event arrangements and logistics. The primary duties include:Organizing the daily arrangement of furnishings and equipment in accordance with event layoutsMaintaining cleanliness of seating, walls, and...


  • Atlanta, Georgia, United States Visionaire Partners Full time

    Project Coordination SpecialistAn exciting opportunity with a leading global organization. As a Project Coordination Specialist, you will be engaged in various initiatives that are currently in the planning stages. This team plays a crucial role in executing retail store merchandise transformations, which includes the procurement of signage, fixtures, and...


  • Atlanta, Georgia, United States Piedmont Medical Care Corporation Full time

    Position Overview:The Clinical Nurse Specialist for Advanced Lung Disease acts as a key clinical liaison within the ALD Program, focusing on outpatient care.Under the supervision of ALD medical professionals, the specialty nurse will oversee clinical operations in alignment with established orders, protocols, and policies.Key Responsibilities:Manage incoming...


  • Atlanta, Georgia, United States Grady Health System Full time

    Job SummaryThe Patient Care Coordinator will be responsible for enhancing the patient experience in Breast Imaging by providing navigation services from screening mammograms to diagnostic services and onto the treatment process by providing individualized assistance to patients and families.Helps patients overcome barriers within and outside the healthcare...


  • Atlanta, Georgia, United States XTalk Prep Full time

    Event Coordination Specialist at XTalk Prep ConsultantsThe Event Coordination Specialist at XTalk Prep Consultants is integral to the successful organization and implementation of various events, ranging from corporate gatherings to extensive conferences. This role requires meticulous attention to detail in managing logistics, collaborating with vendors, and...


  • Atlanta, Georgia, United States ChenMed Full time

    Job SummaryWe are seeking a highly skilled and compassionate Patient Care Coordinator to join our team at ChenMed. As a Patient Care Coordinator, you will play a critical role in ensuring seamless transitions of care for our patients, facilitating communication and collaboration between healthcare providers, and providing exceptional customer service.Key...


  • Atlanta, Georgia, United States Visionaire Partners Full time

    Project Coordination SpecialistAn exciting opportunity with a leading global Fortune 50 Company. As a Project Coordination Specialist, you will engage in various projects that are currently in the preparatory stage, forming part of broader initiatives for the organization. This team plays a crucial role in executing retail store merchandise resets and...


  • Atlanta, Georgia, United States Piedmont Medical Care Corporation Full time

    Position Overview:The Clinical Nurse Specialist for Advanced Lung Disease plays a pivotal role as the clinical liaison within our specialized ALD Program, primarily focusing on outpatient care.In collaboration with ALD healthcare providers, the specialty nurse will oversee clinical operations, ensuring adherence to established orders, policies, and...


  • Atlanta, Georgia, United States Veal Dental Care Full time

    Veal Dental Care Veal Dental Care Atlanta, GA Atlanta, GA Full-time Full-time $20.37 - $29.54 an hour $20.37 - $29.54 an hour Job Overview:Patient Care Coordinator Private, General and Cosmetic dental office is growing and we are in search of an outgoing, self-starter to join our team.Our office is a well-established family dental practice with a commitment...


  • Atlanta, Georgia, United States Emory Healthcare Full time

    Transform Lives Through Nursing At Emory Healthcare, we recognize the profound impact nurses have on patient lives. As a part of our esteemed health system, you will join a team that includes four Magnet-recognized hospitals, dedicated to delivering exceptional patient care. Role Overview As a Clinical Nurse Specialist focusing on Ventricular Assist Device...


  • Atlanta, Georgia, United States Care Runners Home Care Services, Inc. Full time

    Job SummaryWe are seeking a skilled Nurse Care Specialist to join our team at Care Runners Home Care Services, Inc. As a key member of our healthcare team, you will work closely with supervising physicians to assess and monitor patients' needs, ensuring that treatment and care are conducted according to the procedures of the facility.Key...


  • Atlanta, Georgia, United States Grady Health System Full time

    Grady Health System: A Leader in Healthcare Opportunities POSITION OVERVIEW The Clinical Care Order Organizer (O2) plays a pivotal role in the effective management and scheduling of diagnostic tests and procedures across the organization. This position is situated within the HUB (Clinical Care Coordination Center), which oversees the entire hospital's...