Clinic Referral Navigator

Overview The Roseman Medical Group (RMG) Clinic Referral Navigator supports patient care by coordinating referrals, processing documentation, verifying insurance coverage and authorizations, ensuring timely appointments, and facilitating communication between primary care, specialists, and patients. The Clinic Referral Navigator will also serve as a liaison to the Roseman University College of Medicine to support student health compliance, referrals, and medically related excused absences. Responsibilities Clinical Referral & Care Coordination Coordinate and process incoming and outgoing referrals across primary care and specialty services. Assist clinicians in initiating referrals and ensure completeness of clinical documentation. Identify appropriate specialists based on insurance, location, and patient preferences. Track referral status and ensure timely scheduling and completion of specialty appointments. Communicate with patients regarding referral status, expectations, and appointment logistics. Serve as liaison between providers, specialists, and patients to ensure continuity of care. Insurance Authorization & Documentation Management Verify patient insurance eligibility and benefits for referred services using payor systems and established procedures. Obtain and manage prior authorizations in accordance with payor requirements and clinic protocols to prevent delays in care. Ensure all required referral documentation is complete and compliant with payer requirements. Submit, update, and resubmit referrals based on payor responses, coordinating with clinicians for missing information. Maintain accurate and complete records in the electronic medical record (EMR/EHR) and referral systems. Patient Navigation & Barrier Reduction Provides patients with information regarding referral processes, appointment preparation, and follow-up as patients navigate specialty care serving as primary point of contact with patients. Educate patients on referral processes, appointment preparation, and follow-up expectations. Identify and assist with addressing barriers to care (e.g., transportation, scheduling conflicts, language needs). Maintain professional, patient-centered interactions while ensuring professionalism and confidentiality. Medical Student Compliance Monitor and track student health compliance requirements, including immunizations, infectious disease screenings, using platforms such as Complio (American Databank). Coordinate with the Office of Student Affairs to ensure student readiness for clinical rotations. Generate and distribute compliance documentation (e.g., immunization attestation letters) to affiliated clinical sites. Monitor and follow up on drug screening requirements and other institutional compliance measures. Management of Medically Related Excused Absences Coordinate review and processing of student requests for medically related excused absences following established policies and documentation requirements. Collaborate with students, faculty, and Student Affairs to validate documentation and ensure policy adherence. Maintain accurate and confidential records of excused absences. Serve as a resource for students regarding documentation requirements and processes. Collaboration & Administrative Support Work collaboratively with clinicians, administrative staff, and academic leadership. Utilize EMR/EHR systems, referral portals, and institutional databases effectively. Support clinic and academic operations with administrative tasks related to referrals and compliance. Reliable and timely with an on-site presence based on the business needs and in accordance with the University's flexible workplace policy. Perform additional duties as assigned. Requirements Medical Assistant (MA) or Licensed Practical Nurse (LPN) or equivalent healthcare training Minimum of 3-5 years experience in healthcare or clinical settings. Experience working with electronic health/medical records systems. Experience with referral coordination or insurance verification, or prior authorization preferred. Experience in academic medicine or student affairs and familiarity with compliance platforms preferred. Skills Demonstrates excellent written and oral communication skills. Demonstrates working knowledge and experience using an electronic health record. Demonstrates excellent organizational skills and attention to detail with the ability to manage multiple tasks simultaneously. Demonstrates pleasant and professional customer service skills. Shows ability to work independently and collaboratively. Work Conditions While most of the work is computer-based, the position includes a lot of paperwork handling, faxing, and scanning in addition to multiple telephone calls. The position is primarily desk work, involving working on a computer, handling the telephone, coordinating faxes and copies, and researching referral requirements. The position involves interacting with patients face-to-face and via phone and electronic health record communications portals on a daily basis.

Benefits:

403(b) 403(b) matching Dental insurance Disability insurance Employee assistance program Health insurance Health savings account Life insurance Paid sick time Paid time off Vision insurance

Work Location:

In person