Referral Manager

Referral Manager

Under the general supervision of the Director of Utilization Management and Referrals, the Referral Manager serves as the subject matter expert on Referral Department operations and the electronic health record (EHR) system. This role is responsible for staff training, quality assurance, and the oversight of all referral activities, including appointment coordination, issue resolution, tracking referral metrics, and supervising staff. The Referral Manager collaborates with internal and external stakeholders to support organizational goals, with a focus on closing the loop for patient referrals. In addition, this position ensures departmental processes comply with company policies, payer requirements, and regulatory standards to promote cost containment and quality of care. The Referral Manager interacts with a diverse patient population and plays a key role in advancing CHC's Patient-Centered Medical Home, continuity of care, and patient satisfaction initiatives.

It is the primary purpose of CHC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, cooperative, organized, and enthusiastic at all times.

Essential duties and responsibilities include the following. Additional duties may be assigned from time to time :

• Initiates and completes the referral process and is able to instruct and guide staff.
• Assesses daily work by performing chart audits of all Referral Department staff.
• Directs all department activities including scheduling, staffing, and daily operations as well as administrative duties such as a problem resolution and quality assurance monitoring. Throughout the referral coordination process, monitors the status of referral requests to ensure patients secure referral appointments on a timely basis.
• Collaborates with the Director of Utilization Management and Referrals to set productivity goals and monitor performance.
• Provides clear directions, consistent and timely feedback to referral staff. Promotes teamwork in daily activities, exercises diplomacy and consistently uses effective communication skills, acting as a role model to the employees.
• Authorizes time off and will approves time cards. Aligns workload with available staff based on planned and unplanned absences.
• Coordinates and ensures the comprehensive orientation of new department employees and assesses baseline competency. Ensures all Referral Staff have thorough knowledge of the referral process including appointment coordination and closing the loop process.
• Provides support to Health Center Managers, Clinical Service Supervisors and other Administrative staff regarding Referral Management.
• Coordinates and communicates referral status with physicians, patients, and other involved parties to ensure all stakeholders remain informed throughout the referral process.
• Utilizes EHR reports to monitor department and staff performance. Monitor incoming faxes for errors and activities.
• Tracks and reports referral activity to Director of Utilization Management and Medical Administration.
• Completes a modified referral / RAF / follow up assignment daily.
• Maintains appropriate access to hospital portals for medical records and assists referral department staff with obtaining access by acting as hospital relations coordinator
• Orders office supplies and equipment.
• Monitors Referral Department phone activity and staff adherence to customer service phone protocols.
• Communicates with Health Informatics team on Specialists contact information for corrections and adding information.
• Looks for ways to improve and promote Quality and Risk Management.
• May be required to travel to various sites to conduct trainings on the referral process or with providers.
• Promotes an efficient continuity of patient care by initiating or participating in quality improvement projects.
• Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.
• Demonstrates culturally sensitivity and competence with patients.
• Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).

Supervisory responsibilities include interviewing, training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and / or experience : high school diploma or GED required; bachelor's degree in Business, Public Administration, or a health-related field preferred. In lieu of a bachelor's degree, a minimum of five (5) years of healthcare experience is required.

Experience in a referrals department highly preferred.

Prior experience in an FQHC or Community Health Center setting preferred.

Minimum of two (2) years of progressive management or supervisory experience in a health center environment, including referral management, appointment scheduling, insurance verification, or managed care preferred.

Bilingual English / Spanish preferred.

Strong understanding of healthcare operations, including medical terminology and procedures, ICD-10 / CPT coding, insurance plans, and patient referral processes.

Exceptional organizational, problem-solving, and analytical skills, with the ability to manage multiple priorities in a fast-paced environment.

Excellent interpersonal and conflict resolution skills, with the ability to interact effectively with physicians, patients, families, and staff at all levels.

Demonstrated ability to work both independently and collaboratively, with strong attention to detail, initiative, and accountability.

Must have computer proficiency in MS office (Word, Excel, Gmail, Google Docs). Proficiency in AthenaNet is preferred. Proficiency with Health Information Technology (HIT) systems, including report generation.

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Licensed Vocation Nurse preferred.

Required to pass a criminal history background check and drug screen upon hire. Annual health examination; annual Tuberculosis skin test clearance or chest x-ray; proof of immunity to MMR, Varicella, and Hepatitis B; proof of Tdap vaccine; during current flu season, must provide proof of influenza vaccine or a signed declination form. If declined, a flu mask is mandatory during flu season. Health screening requirements are subject to change based on CDC recommendations.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee occasionally is required to sit. The employee is frequently required to stand and walk. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is moderate (i.e. office setting with computers, phones, and printers). Must be able to work in a fast-paced environment.