Referral Manager

Pediatrica Health Group•Miami, FL

14h•Onsite

About The Position

The Referral Manager is responsible for overseeing all referral operations for the Florida region, ensuring timely, accurate, and efficient referral management across all regional offices. This is a full-time, in-person position based out of the corporate office. This position supervises the regional referral team, provides operational leadership, and works collaboratively with providers, specialists, and administrative staff to ensure exceptional patient care and continuity. The Referral Manager also leads the implementation and optimization of the LeadingReach platform, manages pediatric prior authorizations, and develops strategies to improve referral processes, reduce referral leakage, and strengthen specialist partnerships.

Requirements

Strong leadership and team management abilities.
Excellent organizational and time management skills.
Exceptional verbal and written communication skills.
Ability to manage multiple priorities in a fast-paced healthcare environment.
Strong analytical and problem-solving skills.
Attention to detail and commitment to accuracy.
Strong understanding of insurance referrals, pediatric prior authorizations, and managed care processes.
Knowledge of specialist network management and referral best practices.
Proficiency with Microsoft Office Suite and electronic medical record (EHR) systems.
Ability to build collaborative relationships with providers, specialists, staff, and external partners.
Maintains strict confidentiality and full HIPAA compliance.
High school diploma or equivalent required.

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
Experience with referral management systems and electronic health records (EHR); familiarity with LeadingReach preferred.
Prior manager or team-lead experience in a healthcare or referral operations setting preferred.

Responsibilities

Oversee and manage all patient referrals for Florida regional offices.
Ensure referrals are processed accurately, efficiently, and in compliance with organizational policies and payer requirements.
Coordinate referral operations across all Florida offices to maintain consistency and continuity of care.
Collaborate with providers, office managers, and clinical staff to resolve referral issues and improve workflows.
Supervise, train, coach, and support Regional Referral Coordinators to ensure consistent performance and high-quality service.
Provide oversight, guidance, and operational support to referral staff throughout the region.
Lead the implementation, adoption, and ongoing optimization of the LeadingReach referral management platform.
Develop, maintain, and strengthen a narrow network of preferred specialists to improve patient access and coordination of care.
Monitor referral patterns, identify trends, and implement strategies to reduce referral leakage while improving network utilization.
Manage pediatric prior authorizations, ensuring timely submission, follow-up, and approval in accordance with payer requirements.
Maintain current knowledge of insurance guidelines, referral requirements, and prior authorization processes.
Track referral metrics and prepare reports to evaluate departmental performance and identify opportunities for improvement.
Ensure compliance with HIPAA, organizational policies, and regulatory standards.
Participate in process improvement initiatives and support organizational goals related to patient access and care coordination.
Perform other duties as assigned.
Directly supervises the Regional Referral Coordinators throughout the Florida region.