Referral Manager

South Central Family Health Cent•Los Angeles, CA

8d•$70,000 - $75,000

About The Position

Title: Referral Manager Base Salary Range: $70,000 – $75,000 plus benefits FTE: Full-time, Exempt We seek a dynamic and experienced Referral Manager who wants to make a difference in our community. We want to hear from you if you thrive in a fast-paced, caring, and compassionate environment! Our Mission: The Mission of South-Central Family Health Center is to improve the quality of life for the diverse community of inner-city Los Angeles by providing affordable and comprehensive health care and education in a welcoming and multicultural environment. To lead the way in health care in South Los Angeles, as the premier provider and employer of choice offering comprehensive, high-quality, affordable, efficient, and culturally responsive services. General Summary: Supervise and maintain a caseload of clients enrolled in health care programs. Provides leadership to the Referrals team and assists in implementing policies and protocols. Supervise the daily operations of the referral department, ensuring high-quality and timely processing of referrals to minimize delays and reduce insurance denials. Oversee and manage staff performance, including training, coaching, scheduling, conducting evaluations, and administering disciplinary actions as necessary to support team effectiveness and accountability. Ensure timely processing of internal and external referrals and authorizations in accordance with organizational policy and payer requirements. Ensure compliance with HIPAA and other federal/state regulations related to patient information and referrals. Prepare for and actively participate in internal and external audits, ensuring referral department compliance with organizational policies and regulatory standards. Collaborate with the compliance department and other relevant teams to respond to and resolve patient grievances and complaints in a timely and professional manner, ensuring patient satisfaction and adherence to regulatory standards. Assist providers, members and/or internal patients with cases pertaining to referral questions, issues, and authorizations Reconcile claims and pended issues in a timely manner per health plan/department procedures Follows up on all specialists’ reports for medical providers Conducts culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis Participates in case conferences and provide input related to care issues Receive and review incoming phone and case management log reports and determine course of action (i.e., set up authorization or denial per Clinical Director and /or plan guidelines). Develops and implements a client-centered, proactive Care Model Attendance and punctuality are essential in order to provide quality of care to patients, face-to-face interaction with patients, and to work with provided healthcare equipment collected at clinics

Requirements

High School Diploma or equivalent required
BA Degree, required
Demonstrate knowledge of safety, infection control & emergency policies and procedures
Must have a minimum of 2 -3 years in a medical setting
Type 45 wpm
Conduct oneself with professionalism in dealing with sensitive and confidential issues
Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic

Nice To Haves

Working knowledge of medical terminology preferred
Bi-lingual/bi-literate English/Spanish preferred

Responsibilities

Supervise and maintain a caseload of clients enrolled in health care programs.
Provides leadership to the Referrals team and assists in implementing policies and protocols.
Supervise the daily operations of the referral department, ensuring high-quality and timely processing of referrals to minimize delays and reduce insurance denials.
Oversee and manage staff performance, including training, coaching, scheduling, conducting evaluations, and administering disciplinary actions as necessary to support team effectiveness and accountability.
Ensure timely processing of internal and external referrals and authorizations in accordance with organizational policy and payer requirements.
Ensure compliance with HIPAA and other federal/state regulations related to patient information and referrals.
Prepare for and actively participate in internal and external audits, ensuring referral department compliance with organizational policies and regulatory standards.
Collaborate with the compliance department and other relevant teams to respond to and resolve patient grievances and complaints in a timely and professional manner, ensuring patient satisfaction and adherence to regulatory standards.
Assist providers, members and/or internal patients with cases pertaining to referral questions, issues, and authorizations
Reconcile claims and pended issues in a timely manner per health plan/department procedures
Follows up on all specialists’ reports for medical providers
Conducts culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis
Participates in case conferences and provide input related to care issues
Receive and review incoming phone and case management log reports and determine course of action (i.e., set up authorization or denial per Clinical Director and /or plan guidelines).
Develops and implements a client-centered, proactive Care Model
Attendance and punctuality are essential in order to provide quality of care to patients, face-to-face interaction with patients, and to work with provided healthcare equipment collected at clinics