UNICARE COMMUNITY HEALTH CENTER, INC.

Job Summary

The Referral Manager is responsible for developing and managing referral programs to increase customer acquisition and retention. Coaching and mentoring staff and supporting team productivity. Referral Manager is responsible for coordinating the care between the medical providers and the specialists to ensure that the patients are getting the appropriate care. Coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested by clinic providers. Referral Manager a high volume of referrals and pre-authorizations for multiple providers and collaborates with other referral coordinators, providers, MA’s, patient service representatives and other support staff in multiple clinic locations.  This position requires the use of clinical and administrative judgement and initiative to determine best approach for both urgent and non-urgent patient care needs.

Duties/Responsibilities:

• Oversee all referral coordinators and perform hands-on duties as outlined below.
• Serve as a team lead, coaching lower-level staff and supporting team productivity.
• Maintain ongoing interactions with team members to enhance patient care through effective communication and collaboration.
• Review and revise current workflows to ensure maximum effectiveness of the referral process.
• Attend all referral coordination meetings.
• Train all new referral coordinators.
• Participate in interviews, evaluations, and corrective actions for the referral department/coordinators.
• Responsible for the hiring, training, supervision, and evaluation of referral coordinator staff.
• Coordinates comprehensive orientation for new employees and assesses baseline competency.
• Oversees departmental activities including scheduling, staffing, operations, and administrative duties such as problem resolution and quality assurance.
• Hold regular team huddles in person or via Microsoft Teams.
• Hold one-on-one meetings with all referral coordinators.
• Provide necessary training to all referral coordinators.
• Communicate all new information to referral coordinators.
• Collaborate with all clinic care teams as needed.
• Ensure that referral coordinators answer calls and contact patients for messages/voicemails.
• Ensure that approved authorizations are mailed to patients.
• Handle any patient complaints regarding referrals and/or referral coordinators.
• Collaborate with the healthcare team to ensure prompt referral processing.
• Ensure patients can access specialty services promptly.
• Complete all required documentation accurately, thoroughly, and in accordance with clinic standards, ensuring compliance with insurance requirements.
• Prepare all referral and pre-authorization paperwork, gathering pertinent information via EHR, phone, email, fax, or from the clinical team.
• Contact clinics, facilities, and companies to complete referral/pre-authorization requests accurately.
• Responsible for processing referrals submitted by healthcare providers.
• Complete the referral life cycle, including submission, approval, patient notification, follow-up, and securing medical records within specified timeframes.
• Adhere to insurance requirements and communicate with clinicians to process referrals.
• Maintain tracking and documentation on referrals to promote team awareness and ensure patient safety.
• Ensure accurate registration, including patient demographics and insurance information.
• Assemble information on the patient’s clinical background and referral needs.
• Contact review organizations and insurance companies to meet prior approval requirements.
• Review referral details with patients.
• Assist patients with health care system, financial, or social barriers (e.g., interpreters, transportation, prescription assistance).
• Serve as the system navigator and point of contact for patients and families to ask questions and raise concerns.
• Utilize cultural and community resources and maintain relationships with service providers.
• Ensure timely referral processing.
• Remind patients of scheduled appointments via mail, email, or phone.
• Ensure the patient’s primary care chart is up to date with specialist consults, hospitalizations, ER visits, and relevant community health information.
• Respond promptly and appropriately to patient requests.
• Any and all other duties as assigned.

Non-Essential Functions

• As directed supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.

Qualifications and Education

• High school diploma or Equivalent Required.
• Bachelor’s Degree in Business, Public Administration or a health-related field is preferred.
• Preferred substantial clinical experience as an LVN/RN.
• Minimum of two (2) years of progressive management experience in a health center setting including referral management, appointment scheduling, and/or insurance verification.
• Must have ability to understand functions and processes related to healthcare management, including knowledge of medical terminology and procedures, ICD-10/CPT codes, insurance plans and patient referral procedures.
• Knowledge of and experience of EHR.
• Bilingual English/Spanish.

Knowledge, Skills, and Abilities

• Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
• Ability to maintain excellent interpersonal interactions with clients and co-workers as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
• Strong customer service focus.
• Excellent and effective people skills, verbal, written communication skills to partner with a dynamic leadership team.
• Teamwork orientation.
• Organized and able to manage competing priorities.
• Exercise good judgement.
• Resourcefulness in problem solving.
• Able to take and follow through with delegated tasks and accountability
• Advanced knowledge of insurance providers, their portals and their expectations for authorization approval.
• Attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.
• Possess personal qualities of integrity, credibility, and commitment to corporate mission.
• Proficient in Microsoft Word, Excel, and Data Entry.
• Able to work with minimal supervision.
• Must have reliable transportation.

Travel

• May travel to all Unicare Community Health Center clinics to work or attend meetings as needed.

Physical Requirements and Environmental Conditions

• Pushing and pulling objects up to 25lbs.
• Frequent wrist, hand and finger dexterity to perform fine motor function without tremor.
• Full ranger of body motion including twisting body, pushing, pulling.
• Position requires light to moderate work with 25 lb. maximum weight to lift and carry.
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.
• Full range of body motion requires twisting body, pushing, pulling, reaching, bending, stooping, and handling objects with hands and/or fingers, listening, talking, and/or hearing, and seeing.

Working Conditions

• Non-Ionizing Radiation (microwaves)

Work Schedule

• You will generally be scheduled to work each day Monday through Friday, with starting times each day varying between 8:00 a.m. and 9:00 a.m. and ending time between 5:00 p.m. and 6:00 p.m., as required to meet the operational needs of the company. There will be occasional Saturdays as needed.
• You will need to travel to other clinic locations as needed for cross coverage support.