REFERRAL MANAGER

JOB SUMMARY: The Referral manager will oversee and coordinate the referral process. The role manages the referral specialists, optimizes workflows, and collaborates with clinical and operational teams to ensure timely Initiation and follow-up of ordered referrals.

RESPONSIBILITIES:

1. Collaborate with Provider Teams to ensure referrals are done in a timely manner.

2. Run weekly reports on active referrals.

3. Identify gaps in the referral process & create process improvement plans.

4. Track and analyze referral metrics including: turnaround time and completion rates.

7. Assist with obtaining prior Authorizations as required by payer. .

8. Develop and Implement standardized referral workflows and protocols.

9. Monitor referral work queue and address barriers to care

10. Train referral specialists on the referral process from initiation to closure.

11. Provide training and coaching to provider teams.

12. Analyze and resolve issues concerning referral workflow

13. Other assignments may be made at the discretion of the Chief Operations Officer.

Core Competencies:

Communication Skills- demonstrates exceptional verbal and written communication skills to effectively coordinate patient referrals across providers, departments, and external partners. Actively listens to identify gaps in the referral process, and facilitate timely processing. Promotes a culture of collaboration between provider teams and the referral specialists.

Process Improvement & Problem Solving – evaluates workflows to identify potential areas of higher focus, applies critical thinking skills to assess and resolve complex issues as it relates to the referral process. Ability to thoroughly teach/demonstrate the referral process to incoming referral clerks and provider team personnel as needed.

Data Analysis & Performance management –monitors referral metrics and utilizes data to identify trends, gaps, and areas for improvement. Develops and tracks weekly/monthly performance goals. Provides coaching to support staff and referral specialists on the referral process. Actively monitors progress of referral closure.

Care Coordination & Collaboration- works closely with providers, specialists, and care teams. Facilitates smooth transitions of care across internal and external networks. Builds and maintains strong provider and support staff relationships. Collaborates with provider teams and support staff to ensure timely scheduling, information collection, and follow-up of referrals.

PERFORMANCE STANDARDS: Performance will be evaluated by the Director of Behavioral Health annually wherein a satisfactory overall rating is considered a minimum acceptable level of performance.

CUSTOMER SATISFACTION: Must provide the very best customer satisfaction to patients, visitors, and coworkers at all times in a professional and courteous manner. Provide assistance in resolving customers’ problems. Coordinate efforts and interfaces with other departments to resolve problems. Actively protects customer confidentiality. Actively keeps the environment clean and safe with a professional and welcoming image. Always treats customers as welcome guests and provides a warm and sincere greeting. Consistently presents a professional appearance in dress and grooming by adherence to dress code policy. Effectively and regularly demonstrates the values of the organization. Effectively involves customers in decisions that affect them. Follow through in a timely manner of commitments made to customers. Take ownership of your attitude toward Service Excellence.

PERFORMANCE STANDARDS: Performance will be evaluated by the Chief Operations Officer annually wherein a satisfactory overall rating is considered a minimum acceptable level of performance.

HEALTH AND SAFETY:

1. Must adhere to safety policies and procedures.

2. Must receive Safety and Hazardous Communication training annually.

3. Must exercise universal precautions and comply with safety standards and procedures.

4. Knowledgeable OSHA and CLIA requirements to ensure compliance.

PRIVACY RULE COMPLIANCE REQUIREMENTS:

1. Adheres to Health Insurance Portability and Accountability Act (HIPAA Privacy Rule) policies and procedures.

2. Must successfully complete Privacy Rule compliance training annually or as revisions are made to the policies and procedures.

3. Must comply with Privacy Rule guidelines by learning to protect FPHC patients’ medical privacy.

4. Must comply with Privacy Rule guidelines by appropriately maintaining patient information in compliance with national standards.

5. Must comply with Privacy Rule guidelines by providing appropriate security for FPHC patient records.

PROTECTED HEALTH INFORMATION (PHI) ACCESS-RESTRICTED- For purposes of HIPAA Compliance there are 4 workforce categories, which define the level of access to PHI that is granted to the incumbent. This position is classified as PRIMARY PROVIDERS and therefore granted UNRESTRICED access- for the purpose of providing patient care; RESTRICTED access for other uses and disclosures, to be defined according to the purpose for which use or disclosure is intended. Use and disclosure must be in accordance with applicable privacy policies and procedures.

QUALIFICATIONS:

EDUCATION AND EXPERIENCE: Bachelor’s degree of level degree from an accredited college/university holding an independent licensure. Possess a minimum of 3-5 years management experience and clinical coordination. Possess strong administrative, management, and supervisory experience.

KNOWLEDGE, SKILLS AND ABILITIES: Knowledge of clinical procedures and guidelines. Have the ability to instruct, delegate, and supervise a diverse team. Basic office skills such as data entry, filing, phone etiquette, and composition of simple business letters. Possess strong communication skills; verbal, oral, and written. Have an outgoing and friendly personality with the ability to establish effective working relationships. Demonstrate flexibility to undertake a variety of assignments. Possess the ability to organize time efficiently among a variety of duties and the ability to present ideas to community and professional groups.

CERTIFICATIONS, LICENSURES AND REGISTRATIONS: Alabama license (RN, LPN.); valid driver’s license, auto liability insurance.

PHYSICAL/MENTAL REQUIREMENTS:

1. Requires working under stressful conditions or working irregular hours.

2. Must be able to express ideas clearly and concisely; and exercise balanced judgment in evaluating situations and making decisions.

3. Must possess strong oral and written communication skills.

.