Patient Care Referral Coordinator

Description

POSITION DESCRIPTION

POSITION: Patient Care Referral Coordinator

DEPARTMENT: Primary Care

REPORTS TO: Director of Compliance and Risk Management

TYPE: Full Time

Summary:

Under the direct supervision of the Clinical Health Director the Patient Care Referral Coordinator will manage the health center’s referral and authorization process for all health center patients.

Responsibilities

50% Direct Patient Services

• Ensure accurate and complete referral/admission and patient tracking information by initiating and following up on all internal and external referrals on behalf of the Health Centers patients.
• Serve as an Ombudsman for the Health Centers patients and MCO’s or HMO’s regarding access to non-primary care services and coordinating the appeals process for denied services.

50 % Administrative Duties

• Keep detailed, accurate and complete records of referral activities to ensure appropriate visit frequencies as required for each payer per discipline.
• Review utilization and referral reports from all payors, identifying trends and patterns to management and coordinating the distribution of such reports to identified stakeholders.
• Maintain and make available to MCHC providers documented referral protocols, policies and procedures for all contracted MCO’s and HMO’s.
• Participate in the Health Centers outreach and education activities geared towards attracting new members and retaining current membership.
• Performs other related responsibilities as assigned.

Accountability:

Position reports to the Director of Compliance and Risk Management

Requirements

High School graduate with a minimum of two years case management and referral experience.

 Demonstrated knowledge of health care principles and philosophies.

 Excellent communications and organizational skills are a must. Strong interpersonal skills and professional attitude. Word processing and database skills are preferred.