Director of Referral Management

Job Description

Job Description

Paradigm Healthcare is seeking a Director of Referral Management to join our amazing team! We can't wait to connect with you!

Summary / Objective

In keeping with our organization’s goals, the Director of Referral Management will manage the central intake team, Paradigm Referral Management. They will oversee all components of the referral process ensuring high conversion of leads from the creation through admission. This position supervises the PRM department including the Clinical Nurse Evaluators and the Referral Management Specialists.

Job Duties

• Utilizes Clinical Determination Tool to determine clinical acceptance.
• Oversees the denial process.
• Identifies referral care needs, high-cost medications, DME, wound care, etc.
• Understands the referral process including policy, procedures, assessments, and communication requirements.
• Participates in daily CRM calls.
• Maintain a thorough knowledge of the facilities services, clinical capabilities, and physician relationships.
• Onboarding for Paradigm Referral Management Process
• Updates policies and procedures for PRM as needed.
• Provides facility training and support for PRM.
• Utilizes Clinical expertise and experience to help ensure high conversion rates by identifying appropriate potential ways to admit.

Required Education, Experience, and Skills