REFERRAL MANAGER

GENERAL DESCRIPTION OF POSITION:

Referral Manager works under the supervision of the CNO and is responsible for managing and overseeing the Clinic’s referral management and tracking system to ensure timely access to specialty and ancillary care, continuity of care, and compliance with HRSA, Federal Tort Claims Act (FTCA) requirements, and the Clinic’s expectations. The position provides direct supervision to Referral Clerks and ensures implementation of a closed‑loop referral process that mitigates clinical risk and supports quality outcomes. 

ESSENTIAL JOB FUNCTIONS: (with or without accommodations) Responsible for referral management and tracking. The Referral Manager is responsible for managing and overseeing the Clinic’s referral management and tracking system to ensure timely access to specialty and ancillary care, continuity of care, and compliance with HRSA Health Center Program and Federal Tort Claims Act (FTCA) requirements. The position provides direct supervision to Referral Clerks and ensures implementation of a closed‑loop referral process that mitigates clinical risk and supports quality outcomes.  Oversees the end‑to‑end referral process, ensuring all referrals are tracked from initiation through appointment completion, receipt of consult results, provider review, and documented follow‑up.  Ensures that the workflows, policies and procedures align with the HRSA, FTCA, and Clinic requirements. Collaborates with Compliance, Risk Management, and Quality Improvement staff to review and update referral policies as guidance or operational needs change.

Monitors timeframes for referral scheduling, specialist response, and follow‑up actions; initiates escalation when delays or gaps are identified.  Ensures appropriate follow‑up of missed appointments, canceled referrals, and incomplete consultations. Works closely with the Clinical team to maintain ongoing communication with the Clinical team.

Directly supervises referral clerks, including hiring recommendations, scheduling, workload distribution, performance evaluation, and corrective actions.  Provides onboarding, training, and ongoing mentoring related to referral workflows, Athena referral modules, documentation standards, and patient communication.  Conducts routine audits of referral work for accuracy, timeliness, and compliance.  Ensures staff adherence to written referral policies, procedures, and productivity standards.  Monitors the time and attendance policies and employees adherence to the policies.

Serves as an operational lead for referral‑related risk prevention.  Identifies trends or system failures that could result in delayed diagnoses, missed specialty care, or patient harm.  Supports FTCA deeming and re-deeming activities by providing documentation, data, and process descriptions related to referral tracking and staff oversight.  Participates in internal audits, mock site visits, and corrective action planning related to referrals.  Tracks and analyzes referral performance metrics, including referral closure rates, turnaround times, and outstanding referrals.  Prepare routine reports for Executive leadership, Quality Council, Risk Management, Performance Improvement Committees.  Implement corrective actions and workflow improvements when performance falls below established thresholds.  Work collaboratively with providers, care teams, care managers, and external specialists to support timely and effective referrals.  Serves as a point of contact for referral‑related issues and escalations.  Supports patient access to care by addressing barriers such as insurance authorization, transportation challenges, and specialist availability in collaboration with other departments.

Position directly supervised: Referral clerks

Knowledge, Skills, and Abilities: (use of equipment, job related knowledge, language, etc.)

Knowledge of FQHC regulatory and compliance knowledge

Knowledge of clinical referral workflows

Knowledge of organizational structures and community resources.

Skilled in Interdisciplinary leadership and collaboration

Skilled communicating effectively in English and in Spanish.

Skilled in reporting to all levels of an organization.

Skilled in data-driven performance improvement

Skilled in coaching, conflict resolution skills.

Ability to interpret policies, procedures and regulatory requirements.

Ability to manage multiple priorities in a fast-paced clinical environment.

Ability to proficiently use the Athena system and Microsoft Office applications.

Ability to sit, stand, and walk for extended periods.

Ability to operate standard office equipment.

MINIMUM QUALIFICATIONS/CERTIFICATES/LICENSES/REGISTRATIONS REQUIRED:

 Education: Associate’s degree or higher in Healthcare Administration, Health Information Management, Business Administration, or a related field (bachelor’s degree preferred).  Minimum of four (4) years of experience in referral coordination, care coordination, or clinical operations, preferably in an FQHC or safety‑net setting.  Minimum of two (2) years of supervisory or lead experience

 Special instructions: Must have a current driver’s license and liability insurance and ability and availability to work extended hours.