Referral Manager

Community Health Centers of the Central Coast; São Francisco de Assis; Presencial; BRL 80.000 - 120.000; Tempo integral

Resumo da oferta

A regional community health provider seeks a Referral Manager to oversee referral operations, ensure compliance, and manage departmental staff. The role requires a bachelor's degree or extensive healthcare experience, strong leadership skills, and a commitment to quality patient care. A proficient knowledge of healthcare operations and MS Office is necessary. This position is based in São Francisco de Assis, Brazil.

Qualificações

• High school diploma or GED required; extensive healthcare experience preferred.
• Minimum of two years in progressive management or supervisory experience.
• Strong understanding of medical terminology and patient referral processes.

Responsabilidades

• Oversee all referral activities and ensure timely appointment coordination.
• Train and supervise the Referral Department staff effectively.
• Monitor and report on referral performance metrics to management.

Conhecimentos

Healthcare operations understanding

Organizational skills

Interpersonal skills

Problem-solving skills

Formação académica

Bachelor’s degree in Business, Public Administration, or health-related field

Ferramentas

MS Office (Word, Excel, Gmail, Google Docs)

AthenaNet

Descrição da oferta de emprego

Overview

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Reports To: Director Utilization Management (UM) and Referrals

FLSA Status: Exempt

Wage Range the Company Expects to Pay: $3,076.92 - $3,392.31 bi-weekly

Summary

Under the general supervision of the Director of UM 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

• 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 problem resolution and quality assurance monitoring. Monitors the status of referral requests to ensure patients secure referral appointments on a timely basis.
• Collaborates with the Director of UM and Referrals to set productivity goals and monitor performance.
• Provides clear directions, consistent and timely feedback to referral staff. Promotes teamwork, exercises diplomacy, and uses effective communication skills, acting as a role model to employees.
• Authorizes time off and 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).
• Promotes the principle of health care integration and the Patient-Centered Medical Home and Value-Based Care models of healthcare.

Supervisory Responsibilities

Supervises staff within the Referral Department. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, training employees, planning, assigning, and directing work, appraising performance, rewarding and disciplining employees, addressing complaints and resolving problems.

Qualifications

• 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.
• Competencies: 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 independently and collaboratively with strong attention to detail, initiative, and accountability.
• Computer Skills: 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.
• Language Skills: 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.
• Mathematical Skills: Ability to perform basic arithmetic, compute rate, ratio, and percent, and interpret graphs.
• Reasoning Ability: Ability to apply common sense understanding to carry out instructions and deal with problems involving several concrete variables in standardized situations.
• Certificates, Licenses, Registrations: Licensed Vocational Nurse preferred.

Other Requirements

• 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.

Physical Demands

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.

Work Environment

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. Must be able to work in a fast-paced environment.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.