Referral Specialist / Qualified Professional

Job Description

Job Description

Summary:

The Referral Specialist is Southeastern Integrated Care’s system navigator and point of contact for clients, families, multiple referral sources, payers, and our network of providers assuring clients have direct access to immediate and ongoing care and families, with patients and families having direct access for asking questions and raising concerns. Will assertively assume the advocate role on our clients behalf with the referral source and or payer to ensure approval of the necessary services for the client in a timely fashion. Will serve as the primary communicator with all parties involved in the initial intake/admission process of delivering the ongoing care and recovery of our clients.

Essential Responsibilities:

1. Ensure all methods of referrals are captured in EMR system- (i.e., electronic fax, QR codes, alpha and MCO calendars, walk ins, phone, text, etc.
2. Collect all referrals to include all enhanced services and residential (adult/youth).
3. Coordinate/schedule meet/greet with referral sources for youth.
4. Develop relationships with new and existing clients, partners, and stakeholders.
5. Attend community events to learn about new trends and build relationships with industry partners.
6. Identify all referral sources, names, numbers, emails inclusive of direct referral, care managers, hospital or DSS, payer source, etc.
7. Review treatment recommendations of referral source, and Director of clinical Operations
8. Communicate with primary referral sources if client is a NO SHOW or reschedules. Complete referral feedback form and update contact log weekly.
9. Verify coverage insurance options
10. Communicate back with all referrals sources outcomes of CCA and treatment recommendations
11. Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness. The goal is for 95% of all referrals to be admitted to treatment.
12. Ensure complete and accurate registration, including patient demographic and current insurance information.
13. Assist clients with problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
14. Collaborates with Clinical Operations Director and Referral Manager to assure all referrals are accurately assessed and started in the appropriate level of care in a timely fashion

Education/Experience:

• QP level credentials to include 2-3 years of experience working in the healthcare field.
  • Bachelor’s degree in Human Service field with 2 years full-time, accumulated MH/DD/SAS experience with population, OR
  • Bachelor’s degree in a field other than Human Services with 4 years full-time, accumulated MH/DD/SAS experience with population, OR
  • An individual who holds a license of Registered Nurse (RN) in North Carolina, and also has 4 years of experience with MH/DD/SAS population. OR
  • Master’s degree in Human Services field and has 1 year of full–time post-graduate degree accumulated MH/DD/SAS experience with population.
• Flexibility with schedule