Bright HealthCare
SCOPE OF ROLE
The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and underutilization of specialty services based on clinical protocols.
ROLE RESPONSIBILITIES
- Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
- Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
- Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
- Ensures specialist notifications of referral status
- Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
- Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, the status of appropriateness reviews
- Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
- Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
- Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
- Addresses referral based phone calls for the Primary Care Physicians panel and completed phone messages timely
- Facilitates escalation of denied referrals to the clinical team for appeal reviews.
- Adheres to the Policies and Procedures set forth by the Quality Management Committee.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School Diploma
- Minimum 2 years of experience in medical management.
- Capacity to interpret health plan benefit decisions
LICENSURES AND CERTIFICATIONS
- Certification as a Medical Assistant preferred
WORK ENVIRONMENT
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
- Ability to lift at least 50 pounds.
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.