Referral Manager at South Central Family Health Cent

Los Angeles, California, United States -

Full Time

Start Date

Immediate

Expiry Date

15 Jun, 26

Salary

75000.0

Posted On

17 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Supervision, Caseload Management, Policy Implementation, Referral Processing, Authorization Management, Staff Performance Management, Coaching, HIPAA Compliance, Audit Participation, Grievance Resolution, Care Plan Development, Medical Terminology, Bilingual English/Spanish, Professionalism, Initiative, Work Ethic

Industry

Hospitals and Health Care

Description

Description 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 Qualifications and Requirements: High School Diploma or equivalent required BA Degree, required Demonstrate knowledge of safety, infection control & emergency policies and procedures Experience & Abilities: Must have a minimum of 2 -3 years in a medical setting Working knowledge of medical terminology preferred Type 45 wpm Bi-lingual/bi-literate English/Spanish preferred 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 Top benefits or perks: As a team member at South Central Family Health Center, you’ll enjoy competitive wages and generous benefits: Benefits: Health care, dental, life insurance 403 (b) Retirement plan Education Reimbursement

Responsibilities

The Referral Manager will supervise and maintain a caseload of clients in health care programs while leading the referrals team, implementing policies, and overseeing daily operations to ensure timely and high-quality referral processing. Responsibilities also include managing staff performance through training, evaluations, and ensuring compliance with regulations like HIPAA.