Referral Coordinator

Job Purpose:

The Referral Care Coordinator requires direct patient communication, critical thinking and problem solving. The position works closely with the clinical staff and outside agencies to ensure timely processing, tracking and follow-up of external and internal referrals. This position is also responsible for the timely processing of all internal and external medical record request and radiology prior authorizations.

.Essential Job Functions including, but not limited to:

1. Satisfies Core Competencies

• Accepts responsibility for ensuring that performance meets the standards of the professional, ethical and relevant legislated requirements.

2. Care Coordination

• Achieves customer/patient’s satisfaction by greeting and proactively attending to patient needs.

• Explains the details and expectations regarding the referral with patients

• Serves as the system navigator and point of contact for patients and families. Patients and their families will have direct access for asking questions and raising concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion

• Ensures that patient's primary care chart is up to date with information on specialist consults, hospitalizations and ER visits related to their health.

• Coordinates with the Health Information Management (HIM) staff to track the status of all provider reports on patients referred to hospitals, outside clinics and specialty providers.

• Responds to patient’s requests in a timely and efficient manner.

• Maintains confidentiality of patient’s information at work and off duty.

• Relays messages in a timely manner to appropriate health care providers.

• Assists in making patient appointments and placing necessary referrals in a timely manner

• Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety

• Assembles information concerning patient's clinical background and referral needs. Follows referral guidelines, provide appropriate clinical information to specialist

• Contacts appropriate agency/organization to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians

• Ensures that an efficient system of communication and processing medical calls.

Required Education:

• Diploma in nursing or certification in medical assisting

Skills, Licensure and Knowledge Requirements:

• Current LA LPN License or Certification as a Medical Assistant

• Previous experience with medical case management and/or health information management strongly preferred.

• Current Basic Life Support (BLS) Certification required

• Bilingual Preferred

Physical Demands:

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach

• Specific vision abilities required include close vision requirements due to computer work

• Light to moderate lifting is required

Work Environment:

The work environment characteristics described here are representative of those the employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Moderate noise (i.e. business office with computers, phone, and printers, light traffic).

• Ability to work in a confined area.

• Ability to sit at a computer terminal for an extended period of time.

Travel or Special Requirements:

Driving during the workday as well as local or out of state travel may be required to perform job duties.