Care Coordinator

• Develops partnerships with post-acute care facilities participating with inVio Health Network, Community Resources, and Prisma Health Hospital and Physician Leadership.
• Serves as a liaison with the network’s provider partner/member organization(s) and Prisma Health.
• Manages and coordinates network provider site visits.
• Supports the selection of post-acute partners through a formal RFI/RFP process.
• Helps create the RFI/RFP materials, facilitates meetings for the team through the selection process.
• Develops and utilizes systems to continuously audit, evaluate, and report post acute Network composition, performance, and quality improvement.
• Round routinely in Network facilities and/or meets with agency leadership to review performance metrics.
• Serves as a liaison to Prisma Health for any identified opportunities for improvement.
• Coordinates and oversees multi-disciplinary team meetings to improve quality through reduced readmission, utilization, and cost.
• Uses business analytics to forecast, strategize, and identify new opportunities in alignment with value-based quality principles.
• Organizes and leads periodic Collaboratives with post-acute agencies focused on furthering efficient care transitions, enhanced quality, resource transparency, and education opportunities.
• Leads the development and delivery of formal educational offerings and learning labs for internal teams and external post-acute agencies.

Post Acute Program Coordinator for value-based care initiatives in healthcare

Valued Based Care – Post Acute Program Coordinator

Post Acute Program Coordinator managing partnerships with post-acute care facilities for Prisma Health's value-based care strategy. Overseeing quality performance and engaging with key stakeholders across the network.

• Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals
• Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions
• Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
• Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions
• Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans
• Serves as member advocate through continued communication and education
• Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members
• Ensures coverage for appropriate services within benefit and medical necessity guidelines
• Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)
• Participates in data collection/input into system for clinical information flow and proper claims adjudication

Care Manager improving health outcomes for oncology patients with BlueCross BlueShield

Managed Care Coordinator II – Oncology Focus

Care Manager focusing on care coordination for oncology patients at BlueCross BlueShield. Evaluating outcomes and advocating for members with chronic conditions remotely.

• Play a critical role in ensuring the success and stability of foster placements by supporting both the youth and the caregivers.
• Conduct home visits.
• Provide case management and support to foster families.
• Coordinate services, manage documentation and compliance tasks.
• Collaborate with internal staff and community partners.
• Assist with administrative tasks, engage in marketing and outreach efforts, and enhance the program’s social media presence.
• Participate in an on-call weekend rotation to ensure 24/7 support and coverage for foster families in case of emergencies or urgent needs.

Foster Care Coordinator ensuring success and stability of foster placements

Foster Care Coordinator

Foster Care Coordinator at Thompson Child & Family Focus ensuring success and stability of foster placements through various support roles. Supporting youth and caregivers while collaborating with community partners.

• Own high-volume inbound patient and provider communication queues across phone, email, chat, and SMS, responding quickly while maintaining accuracy and professionalism.
• Serve as the first point of contact for patients, resolving inquiries in real time without unnecessary handoffs.
• Schedule, reschedule, and coordinate appointments accurately, ensuring clean handoffs to GI Providers, Registered Dietitians, and Behavioral Health Providers.
• Respond to billing and insurance questions, clearly explaining benefit design and cost-share in a way patients can understand.
• Triage clinical questions accurately, manage pharmacy inquiries, and coordinate prescription and refill requests with urgency and attention to detail.
• De-escalate challenging interactions with confidence and empathy while documenting all patient interactions accurately in real time.
• Proactively identify workflow inefficiencies and suggest improvements that increase speed and patient satisfaction.

Care Coordinator managing patient communications for digestive health at Oshi Health

Care Coordinator managing patient communications for digestive health at Oshi Health. Serving as the first point of contact for patients navigating their digestive health journey.

Care Coordinator jobs in South Carolina

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Valued Based Care – Post Acute Program Coordinator

Managed Care Coordinator II – Oncology Focus

Foster Care Coordinator

Care Coordinator