Referral Coordinator III

Referral Coordinator III

The Referral Coordinator III serves as a senior member of the Referral Coordination team, providing day-to-day workflow guidance, subject matter expertise, and operational support to ensure efficient, high-quality Referral Coordination services. In addition to managing a complex caseload and performing all core Referral Coordinator responsibilities, this role supports team productivity, quality outcomes, process improvement initiatives, and the implementation of Referral Coordination best practices.

Working closely with the Referral Coordination Manager, the Referral Coordinator III acts as a resource for colleagues, helps identify and address operational barriers, assists with onboarding and training, and provides feedback on team performance and process effectiveness. This role requires advanced knowledge of referral management, healthcare operations, and Referral Coordination workflows, along with a strong commitment to member experience and clinical excellence.

Duties/Responsibilities:

• Provide day-to-day oversight of assigned Referral Coordination pod activities, including call queue management, referrals, durable medical equipment (DME), and diagnostic imaging (DI) workflows, ensuring productivity, quality, and service standards are met.
• Monitor and communicate team and individual productivity and quality outcomes, providing the Referral Coordination Manager with insights regarding performance trends, barriers, opportunities for improvement, and key achievements.
• Deliver an exceptional member experience by managing member communications, including returning calls, routing inquiries appropriately, and providing timely updates and information regarding referrals, diagnostic imaging orders, and related services.
• Participate in the recruitment and interview process for Referral Coordinator positions.
• Support the onboarding and precepting of new referral coordinator colleagues.
• Support the implementation and pilot testing of new workflows, processes, and initiatives, providing detailed feedback and recommendations to process owners and leadership.
• Serve as a subject matter expert and primary resource for daily workflow guidance, problem resolution, and Referral Coordination best practices.
• Coordinate referrals to external providers, vendors, and services to ensure members receive timely access to appropriate care and resources.
• Maintain accurate, complete, and timely documentation to support referral management and continuity of care.
• Build and maintain strong relationships with members and their families to facilitate effective Referral Coordination and a positive member experience.
• Carry out activities outlined in members' care plans and support ongoing follow-up to ensure care plan goals and recommended services are completed.
• Promote effective communication and collaboration among care teams, providers, specialists, and external partners to support positive member outcomes.
• Assist members in navigating healthcare, financial, and social barriers to care, including coordination of transportation, interpreter services, prescription assistance, and other support resources as appropriate.
• Serve as a trusted point of contact and system navigator for members and families, addressing questions, concerns, and Referral Coordination needs.
• Maintain compliance with HIPAA regulations and all organizational policies related to privacy, confidentiality, and protected health information (PHI).
• Partner with center, market, and enterprise stakeholders to support Referral Coordination goals and organizational priorities.
• Facilitate communication between Referral Coordination teams and leadership to promote consistency and best-practice sharing.
• Support change management efforts and champion adoption of new workflows and processes.

Required Skills/Abilities:

• Demonstrates a high degree of emotional intelligence, integrity, professionalism, and accountability, with a strong results-oriented work ethic.
• Self-motivated and resourceful, with the ability to think strategically, solve complex problems, and execute effectively in a dynamic environment.
• Builds strong relationships and collaborates effectively with colleagues, providers, members, caregivers, vendors, insurance partners, and leaders across all levels of the organization.
• Exceptional verbal and written communication skills, with a customer-centric approach and the ability to influence diverse stakeholders.
• Strong critical thinking, decision-making, and problem-solving skills, with the ability to assess risks, identify root causes, and implement sustainable solutions.
• Demonstrated ability to manage multiple priorities simultaneously while maintaining a high degree of organization, accuracy, and attention to detail.
• Ability to develop constructive and cooperative working relationships that foster trust, engagement, and collaboration.
• Provides performance feedback, coaching, and competency assessments to support colleague development and continuous improvement.
• Strong understanding of healthcare operations, Referral Coordination, utilization management, and value-based care principles.
• Deep knowledge of the healthcare ecosystem, including payer operations, insurance benefits, referral management, and authorization processes.
• Experience interpreting and analyzing claims, quality, utilization, and operational performance data to identify trends and drive improvements.
• Familiarity with healthcare analytics and reporting tools and the ability to translate data into actionable recommendations.
• Working knowledge of medical terminology, CPT and ICD-10 coding, and Medicare coverage criteria related to equipment, supplies, and specialty services.
• Passion for improving health outcomes and supporting seniors in successfully navigating their care journey.
• Proficiency with Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook, and other business productivity applications.
• Bilingual skills, including Spanish or other languages commonly spoken in the communities we serve, are preferred where applicable.
• Ability and willingness to travel periodically for training, meetings, and business needs.
• Embodies and serves as a role model of ArchWell Health values: Be compassionate, strive for excellence, earn trust, show respect, stay resilient, and always do the right thing.

Minimum Qualifications:

• High School Diploma or equivalent required; Associate's degree or coursework in Healthcare Administration, Health Sciences, or a related field preferred.
• Graduation from a nationally accredited Medical Assistant program or equivalent healthcare vocational training (e.g., paramedic, military medic, foreign-trained physician, or similar clinical background) preferred.
• Minimum of three (3) years of experience in referral management, Referral Coordination, or healthcare operations within a primary care, managed care, or value-based care environment required.
• Demonstrated experience managing complex referrals, authorizations, specialty scheduling, diagnostic imaging, and durable medical equipment (DME) processes preferred.
• Experience serving as a mentor, trainer, subject matter expert, or informal team lead preferred.
• Experience working with Medicare populations and geriatric patients strongly preferred.
• Proficiency in eClinicalWorks required.

About ArchWell Health:

At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.