Referral Specialist Lead in San Juan Capistrano, California at Mission Hospital Camino Health Center

Under the direction of the Population Health Manager, the Referral Specialist Lead works as part of a patient care team to provide high quality, efficient and service oriented patient care while demonstrating the health center’s core values. In addition to performing the full scope of referral specialist duties, the Referral Specialist Lead provides day-to-day supervision, mentorship, and workflow oversight to the referral specialist team. Working alongside physicians, mid-level providers, registered nurses and medical assistants, the Referral Specialist Lead is responsible for receiving, processing, scheduling, and following up on all medical referral requests, including in-house and outside referrals for diagnostic testing, medical specialists, or other providers. The Referral Specialist Lead also assists in the coordination and organization of patient care services.

Ensure that the core values of Camino Health Center – Service, Dignity, Justice and Excellence are carried out within daily tasks.

Essential Values-Based Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the mission of the Camino Health Center.

Dignity: Demonstrates competence in communication and interpersonal relations

Excellence: Demonstrates competence in continuous improvement, continuous learning, and teamwork/collaboration

Service: Demonstrates competence in customer/patient focus, adaptability, and shaping change

Justice: Demonstrates competence in community orientation, stewardship, and strategic planning and action

Essential Functions:

Patient Relations

• Work diligently, cooperatively, and effectively with patients, medical providers, health center staff and community stakeholders in all aspects of patient care and care coordination.
• Provide positive, supportive and caring behavior in all communications to patients, community stakeholders and staff.
• Maintain patient confidentiality and HIPAA practices at all times.

Patient Referrals

• Obtains and processes referrals from providers and communicates authorizations with patients (via phone & mail) and medical staff in a timely manner.
• Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned members.
• Tracks referrals in the electronic medical records (EMR) system; Follows up on submitted authorization requests and maintains consistent status updates via EMR.
• Monitors and reports on statuses of authorization requests; escalates issues as necessary until fully resolved and referral loop is closed.
• Communicates referral and authorization information and pertinent medical information to the patient and specialty providers.
• Manages the need for redirection across all clients and payers by working with clinical teams to ensure timeliness of re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.
• Reviews consultation reports for needed follow up requests and works with providers to ensure timely processing of all follow ups.
• Works with the health information (medical records) department to ensure timely retrieval of consultation reports.
• Assists patient with scheduling appointments with the specialist should the patient express any challenges in accomplishing this themselves.
• Submits retro-authorizations and distinguishes between primary care and internal specialty visits.

Provider & Team Support:

• Participates in daily morning care team huddles and scheduled department meetings.
• Screens and answers related referral calls by telephone, patient portal, patient walk-in and/or by mail.
• Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling.
• Shares accountability of overall participant health outcomes, working in coordination with care teams.
• Advocates and discusses with participants all aspects of the referral process as needed or requested by the treating provider.
• Arranges transportation for participants to medical appointments at Camino Health Center and other organizations.
• Documents all actions taken in the participant medical record in accordance with current Clinic, DHCS and CMS regulations/guidelines.
• Acts as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources.

Lead Supervision & Escalation Management:

• Provides day-to-day oversight, coaching, and mentorship to assigned referral specialists to support consistent performance and adherence to standard workflows. Serves as the first point of escalation for complex, urgent, or unresolved referral cases, applying clinical and payer knowledge to drive timely resolution.
• Monitors team workload distribution and referral queue status, proactively identifying and addressing bottlenecks.
• Assists the Population Health Manager with onboarding and training of new referral staff, including orientation to standard work, EMR documentation, and payer-specific processes. Participates in quality review activities including audits of referral documentation and closure rates.
• Communicates team performance trends and escalation patterns to the Population Health Manager. Supports coverage planning and cross-site coordination to maintain continuity of referral operations across all Camino Health Center locations.

Additional Responsibilities:

• Performs other duties as assigned by supervisor

Knowledge / Skills / Abilities:

• Work collaboratively with people of all ages, social, and ethnic backgrounds
• Work independently and as part of a team
• Ability to work in a fast paced environment
• Basic/Excellent oral and written communication; basic math skills
• Ability to convey a sense of confidence and trust to all patients
• Ability to relate well to other health professionals and support staff
• Ability to carry out administrative and patient support services
• Ability to maintain patient confidentiality

Age-Related Competencies:

• Demonstrates the ability to meet the age related needs of the specific population served

Information Management:

• Treats all information and data within the scope of the position with appropriate confidentiality and security

Risk Management:

• Cooperates fully in all risk management activities and investigations

Safety Requirements:

• Knowledge of, observes, and complies with clinic safety policies and emergency procedures

Additional Requirements:

• Able to work flexible hours, including evenings and weekends
• Able to work at various health center locations and outreach sites

Minimum Position Qualifications:

• Education: High school diploma/GED required
• Experience / Training: Three or more years of clinical or healthcare experience required, with at least two years in a referral coordination or authorization role
• Language: Bilingual (English/Spanish) required
• Lead / Supervisory Experience: One year of lead, supervisory, or team mentorship experience required; demonstrated ability to guide and support peers in a clinical or healthcare administrative setting

Preferred Position Qualifications:

• Experience with referral authorization and data processing preferred
• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology
• Excellent planning and organizational ability