Humana Referral Coordinator-Bilingual English/Spanish, Continucare Miami/Blue Lagoon in Miami, Florida

Role: Referral Coordinator Assignment: Care Delivery/Continucare Location: Miami/Blue Lagoon

Role Description: As a Referral Specialist you will contribute to Humana’s integrated care delivery strategy by assisting in the coordination of specialty and ancillary care for our patients in a timely and professional manner. In this role, individuals will perform the following functions: * Process referrals from primary care providers for specialty and ancillary care in a timely manner, prioritizing the referrals according to defined levels of urgency, scheduling member appointments as necessary and communicating referral information to patients.

  • Collect information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to reviewing clinicians and specialists. Present necessary medical information such as history, diagnosis and prognosis.

  • Remind patients of scheduled appointments via mail or phone.

  • Assist patients in 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). Identify and utilize cultural and community resources.

  • Establish and maintain relationships with identified service providers.

  • Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety and access to care.

  • Contact review organizations and insurance companies to ensure prior approval requirements are met.

  • Ensure consultation reports are received from the consulting provider to maintain continuity of care.

  • Partners with Network Development to ensure specialist network is adequate for the geography and escalates accordingly when network adequacy impacts access to care.

  • Demonstrate respect for the privacy and confidentiality of patient’s protected health information

  • Other duties as assigned.

    Required Competencies:

  • Demonstrated ability to create an exceptional patient experience leveraging excellent customer service skills

  • Excellent communication skills. Ensures understanding regardless of the communication vehicle; understands the needs and perspectives of others and tailors delivery accordingly; shares information appropriately; actively listens

  • Interpersonal effectiveness (emotional intelligence): Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships

  • Ability to work well with a team; Develop and manage interpersonal relationships with entire care team

  • Responsibility for achieving organizational goals and accountability for results. Meets established expectations and takes accountability for results; encourages others to do the same

  • Strong organization and time management skills with the ability to prioritize and multi-task. Organizes and manages multiple priorities and/or projects using appropriate methodologies and tools.

  • Self-motivated and committed to achieving best results

  • Possesses critical thinking skills, independent decision making capability

  • Proactively identifies, evaluates, and solves problems with logic and a systematic approach; looks beyond the obvious to see root cause issues and creative solutions. Makes appropriate decisions in the face of ambiguity. Anticipates and resolves barriers and constraints.

  • Understanding of the health care delivery process and utilization management concepts

    Role Requirements:

  • High School Diploma or GED

  • Proficient with medical terminology and familiar with CPT-4 and ICD-9/10 coding

  • 6 months or more of hands-on healthcare experience in a clinical setting, preferably within the Medicare population

  • Proficient computer skills with the ability to adapt to and learn new systems quickly

  • Proficient with Microsoft Office applications including Microsoft Word, Excel and Outlook

  • Experience with Electronic Medical Records

  • Bilingual English/Spanish (fluent levels in both)

    Role Desirables:

  • Bachelor’s Degree in Healthcare or Business Administration

  • 2 years or more of hands-on healthcare experience in a clinical setting, preferably within the Medicare population

  • Medical Assistant or Professional State Certifications related to healthcare

Job Business Services

Title: Referral Coordinator-Bilingual English/Spanish, Continucare Miami/Blue Lagoon

Location: FL-Miami

Requisition ID: 168992