Care Coordination Spec

Hackensack University Medical Center Manahawkin , NJ 08050

Posted 3 weeks ago

Overview

How have you impacted someone's life today? At Hackensack Meridian Health our healthcare teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career all within New Jersey's premier healthcare system.

The Care Coordination Specialist performs selected services and functions related Transitions of Care & Utilization Management, including insurance authorization, payer communications, Appeals and Denial information, and scheduling.

Responsibilities

The day in the life of a Care Coordination Specialist at Hackensack Meridian Health inclides:

  • Responds to requests and inquiries and provides information as requested

  • Prepares required Appeals and Denial information for processing and follows up on receipt of communication including Livanta appeal management process

  • Providing patients with the IM Letter from Medicare prior to discharge

  • In collaboration with the Care Coordinator, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CC to potential problems with any of the above

  • If the authorization/precert information is missing or incorrect, the Specialist will contact admitting to obtain the necessary and accurate information

  • Contacts insurance company for benefit coverage and obtains authorizations when needed; SAR; Ambulance Transport; or Other

  • Manages Referrals to external facilities & services including but not limited to the following:

  • Assisted Living Facilities

  • Acute Rehab

  • Subacute Rehab

  • New referrals & Returns
  • LTAC
  • Hemodialysis
  • New & Returns
  • DME

  • Hospice

  • Palliative Care

  • Wound Care

  • Home Health Services

  • Community Resources

  • As requested arrange Medicaid appointments.

  • As requested will arrange follow up appointments at MD's office and/ or clinics

Qualifications

  • High school diploma or equivalent is required

  • Experience in the healthcare industry is required

  • 3 years recent experience in a hospital or medical setting is preferred

  • Educated in the unique clinical and discharge needs of the patients is required

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Care Coordination Spec

Hackensack University Medical Center