Referral Navigator Representative

Job Summary

To support the Medical Management Department, the part-time Referral Navigator Representative will coordinate care navigation and referral processes, ensuring timely communication and service delivery while working remotely from anywhere within the U.S.

Key responsibilities:

• Serve as a centralized resource for care navigation, supporting referral completion and continuity of care activities
• Perform initial review and validation of clinical and administrative documentation for authorization and regulatory processing
• Coordinate with various stakeholders, including physicians and healthcare providers, to facilitate patient care requests

Required qualifications:

• High School diploma or GED from an accredited program
• 2+ years of experience in managed care, utilization management, or healthcare operations
• Experience interacting with healthcare providers and managing authorizations or referrals
• Familiarity with electronic medical records (EMR) and healthcare information systems
• Knowledge of medical terminology, referral management, and authorization processes