Referral Navigator Representative

Job Summary

Supporting patient care coordination, the remote Referral Navigator Representative will manage referral completion, home health services, and durable medical equipment requests while ensuring effective communication among healthcare providers and patients.

Key responsibilities

• Coordinate and facilitate timely progression of patient care requests across various healthcare stakeholders
• Perform initial review, triage, and validation of clinical and administrative documentation for authorization and regulatory processing
• Support the organization's Closed the Loop program by monitoring and coordinating activities to ensure members receive requested services

Required qualifications

• High School diploma or GED from an accredited program
• 2+ years of experience in managed care, care coordination, or healthcare operations
• Experience interacting with healthcare providers, clinical staff, and members regarding services and authorizations
• Proficiency in utilizing electronic medical records (EMR) and healthcare information systems
• Knowledge of medical terminology, referral management, and authorization processes