Senior Manager, Referrals & Care Coordination

Harbor Health; Austin (TX); On-site; USD 150,000 - 195,000; Full time

Benefits offered by this job

Competitive salary and benefits

Generous PTO

10 paid holidays

Medical, Dental, and Vision Insurance

401(k) Investment Plan

Professional development and growth

Collaborative culture

Job summary

Harbor Health in Texas is seeking a Senior Manager of Referrals to lead the referral management function across our payvider model, owning intake, triage, authorization coordination, scheduling, and closing the loop with providers. You will build strategy, team, and processes to connect members to timely, in-network care while managing total cost of care.

This high-visibility leadership role partners with clinical and operations leaders across Texas.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field, or equivalent experience is desired; Master's degree preferred.
• 7+ years of healthcare operations experience in referral management, utilization management, prior authorization, care coordination, or patient access.
• 3+ years of people leadership experience, including leading managers or multi-site teams.
• Working knowledge of referral and authorization requirements and applicable state and federal regulations, including Texas utilization review requirements and accreditation standards.
• Experience in a managed care, payvider, integrated delivery, or medical group environment.
• Demonstrated ability to use data and KPIs to drive performance, with proficiency in Excel and reporting or BI tools.
• Experience with EHR and referral or utilization management platforms.
• Strong communication, relationship-building, and change management skills, with the ability to influence clinical and operational leaders.
• Preferred: Clinical licensure (e.g., RN), Lean or Six Sigma training, experience in value-based care, and bilingual English/Spanish skills.

Responsibilities

• Own the end-to-end referral management program across the medical group and health plan, including intake, triage, authorization coordination, scheduling, tracking, and closing the loop with referring providers.
• Develop and execute policies, workflows, and referral pathways that direct members to high-quality, in-network, Harbor Health specialty care to improve access, outcomes, and total cost of care.
• Define, monitor, and report key performance indicators, including referral turnaround time, completion rate, network utilization and leakage, authorization approval and denial rates, appointment wait times, and member and provider satisfaction.
• Lead, coach, and develop a team of managers, supervisors, and referral coordinators across Harbor Health markets.
• Set staffing models, productivity and quality standards, and training programs to ensure consistent, high-performing referral operations.
• Partner with Clinical leadership, Medical Management and Utilization Management, Network and Provider Contracting, Claims, Provider Relations, Care Management, and Member Services to align referral practices with clinical and financial goals.
• Serve as the escalation point for complex referral issues and for provider and member concerns.
• Serve as the primary operational lead for referral vendor relationships, holding vendors accountable for performance against contracts, scopes of work, SLAs, and quality standards.
• Conduct regular vendor performance reviews using data on turnaround times, productivity, accuracy, rework, and escalations with corrective action plans.
• Identify and escalate recurring performance failures, unresolved issues, and work outside the contracted scope to leadership and contracting partners.
• Ensure referral and authorization processes comply with applicable state and federal regulations, accreditation standards, and contractual timeframes.
• Support audits and regulatory reviews, and work with Utilization Management to monitor denial, appeal, and delay trends.
• Evaluate, configure, and optimize referral and authorization workflows within the EHR and utilization management platforms, partnering with IT, Analytics, and external vendors, including TPA partners.
• Identify and implement automation and process improvements that reduce manual work and speed up access to care.
• Manage departmental budget, staffing plans, and vendor performance.

Skills

Leadership

Data-driven decision making

Communication

Change management

Bilingual English/Spanish

Education

Bachelor's degree in Healthcare Administration, Business, Nursing, or related field

Master's degree preferred

Tools

Excel

BI tools

EHR systems

Referral/Utilization mgmt platforms

Job description

Harbor Health in Texas is seeking a Senior Manager of Referrals to lead the referral management function across our payvider model, owning intake, triage, authorization coordination, scheduling, and closing the loop with providers. You will build strategy, team, and processes to connect members to timely, in-network care while managing total cost of care.

This high-visibility leadership role partners with clinical and operations leaders across Texas.