Referral Manager presso FoundCare, Inc.

Description

PRIMARY PURPOSE:

The Patient Referral Manager is responsible for overseeing and optimizing the patient referral process to ensure timely, accurate, and patient-centered coordination of care. This role involves managing referral staff, collaborating with healthcare providers and insurance companies, and using data to drive process improvements. The Referral Manager ensures compliance with healthcare regulations and fosters strong relationships with both internal and external stakeholders to support the organization's goals.

ESSENTIAL JOB FUNCTIONS:

• Process Management: Oversee the end-to-end referral process using EHR systems.
• Patient Communication: Inform patients about referral status, appointments, and next steps.
• Provider & Insurance Liaison: Coordinate with providers and insurers to obtain authorization and resolve issues.
• Data & Reporting: Track referral metrics and generate reports for leadership.
• Staff Supervision: Lead and train Referral Coordinators and/or team members.
• Process Improvement: Identify inefficiencies and implement workflow enhancements.
• Compliance: Ensure adherence to HIPAA and other healthcare regulations.
• Relationship Management: Maintain strong relationships with internal departments and external providers.

Requirements

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Strong verbal and written communication.
• Excellent organization and time management.
• Problem-solving and critical thinking.
• Knowledge of insurance plans and medical coding.
• PC proficiency.
• Proficiency in HER and CRM systems.
• Attention to detail.
• Leadership and team collaboration.
• Ability to build rapport with patients, providers, and staff.
• Strong customer service orientation.
• Conflict resolution and negotiation skills.
• Ability to read, write, and effectively communicate in the English language, with or without the use of auxiliary aids or services.
• Ability to review, understand, and apply concepts presented in training programs, conferences, and/or professional literature.
• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.
• Ability to interact and work with diverse populations.

PHYSICAL REQUIREMENTS:

• Ability to endure short, intermittent, and/or long periods of sitting and/or standing in performance of job duties.
• Full range of body motion required. Position requires reaching, bending, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.
• Ability to lift and carry objects weighing 25 pounds or less.
• Accomplish job duties using various types of equipment/supplies, e.g. pens, pencils, calculators, computer keyboard, telephone, etc.
• Ability to travel to other FoundCare locations and perform job duties.
• Ability to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms.

MINIMUM QUALIFICATIONS:

· Education: 

• Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field required. 
• Master’s degree or additional certifications (e.g., Certified Medical Manager, Certified Referral Specialist) preferred.

· Experience:

• Minimum of 3–5 years in healthcare referral coordination or care management.
• At least 2 years in a supervisory or leadership role.
• Experience working with insurance companies and prior authorization processes.

· Technical Proficiency:

• Familiarity with electronic health record systems (e.g., Epic, Cerner).
• Skilled in Microsoft Office Suite and CRM platforms.
• Ability to analyze data and generate actionable insights.

· Regulatory Knowledge

• Understanding of HIPAA, CMS guidelines, and other healthcare compliance standards.