Sr. Manager, Referrals

HARBOR HEALTH; United States; A distancia; USD 140.000 - 190.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive salary

Generous PTO

10 paid holidays

Medical, Dental, Vision Insurance

401(k) Plan

Professional development

Transparent culture

Collaborative work environment

Descripción de la vacante

Harbor Health seeks a Senior Manager of Referrals to lead a comprehensive referral management program across its payvider model, ensuring intake, triage, authorization, scheduling, and close collaboration with primary care and specialty providers.

You will set policies, workflows, and staffing standards while driving KPIs and cost-conscious care; you will manage internal teams and outsourced vendors, aligning with clinical and financial goals.

Formación

• 7+ years in healthcare operations with referral management, utilization management, or patient access.
• 3+ years of people leadership including multi-site teams.
• Experience with EHR and referral/authorization platforms.
• Lean or Six Sigma training and value-based care experience preferred.
• Bilingual English/Spanish skills preferred.

Responsabilidades

• Own end-to-end referral management across medical group and health plan, including intake, triage, authorization coordination, scheduling, and closure with providers.
• Develop policies, workflows, and referral pathways to direct members to in-network Harbor Health care.
• Define and monitor KPIs: turnaround time, completion rate, utilization, approvals/denials, wait times, satisfaction.
• Lead and develop a managers and coordinators team across Harbor Health markets.
• Oversee vendor performance and contract adherence; enforce SLAs and quality standards.
• Ensure compliance with state/federal regs and audits; support utilization management reviews.

Conocimientos

People leadership

Data-driven decisions

Excel

BI tools

EHR systems

Change management

Communication

Bilingual English/Spanish

Educación

Bachelor's in Healthcare Admin

Master's degree preferred

Herramientas

EHR platforms

Referral/Utilization platforms

Descripción del empleo

Harbor Health is seeking a Senior Manager of Referrals to lead the referral management function across our payvider model, which integrates a medical group with a health plan. In this role, you will own the end-to-end referral experience, from intake and triage through authorization coordination, scheduling, and closing the loop with primary care and specialty providers. You will build the strategy, team, and processes that connect members to timely, high-quality, in-network care while helping Harbor Health manage the total cost of care.

This role also leads internal referral operations and oversees outsourced referral services, holding vendor partners accountable for contractual obligations, service-level agreements, quality standards, and timely resolution of performance issues. This is a high-visibility leadership role that partners closely with clinical, medical management, network, and operations leaders across Texas.

POSITION DUTIES & RESPONSIBILITIES

Referral Strategy & Operations

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, and 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.

Cross-Functional Partnership

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.

Vendor performance and Contract Accountability

Serve as the primary operational lead for referral vendor relationships, holding vendors accountable for performance against executed contracts, agreed scopes of work, service-level agreements, and quality standards.

Conduct regular vendor performance reviews using validated data on turnaround times, productivity, accuracy, rework, and escalations. Require documented corrective action plans when expectations are not met, establish deadlines, and verify sustained improvement.

Identify and elevate recurring performance failures, unresolved issues, and work outside the contracted scope to leadership and the appropriate contracting partners.

Compliance & Quality

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.

Systems, Process Improvement & Budget

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.

DESIRED PROFESSIONAL SKILLS & EXPERIENCE

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.

WHAT WE OFFER

Competitive salary and benefits package

Generous PTO

10 paid holidays

Medical, Dental, and Vision Insurance

401(k) Investment Plan

Professional development and growth opportunities

A transparent and unique culture

Collaborative and dynamic work environment

COMPANY OVERVIEW

At Harbor Health, we're transforming healthcare in Texas through collaboration and innovation. We're seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you're ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!

EQUAL EMPLOYMENT OPPORTUNITY

Harbor Health is an Equal Opportunity Employer. We celebrate diversity and are committed to building an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected characteristic.