Referral and Care Coordinator

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family.  PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area.  PCHP works to fulfill of our mission by empowering members to live healthier lives.  By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it’s a passion to serve and improve lives every day.

Coordinates non-clinical referral process for outpatient visits. In collaboration with the nurse navigator and PFS, serves as a liaison for referring providers, patients / families, physicians, nurses and other core members of the interdisciplinary teams and department; ensures appropriate access for new and transitioning patients into the practice.  This is a Full Time 40 hour per week position.   Monday through Friday  8 to 4 : 30 pm

Minimum Specifications

Education

• High School Diploma or equivalent required

Experience

Skills or Special Abilities

Responsibilities

1.           Receives and reviews all clinical referrals for appropriateness based on established criteria, conferring with appropriate clinical staff for circumstances outside of the given scheduling pathways for clinical management. Ensures referral is assigned to the patients appointment / account. Facilitates required work ups are completed and places SDO for labs, as required for specialty services for new patients.

2.           Consults with Patient Finance Services for financial counseling to ensure assignment of the proper financial classification for reimbursement enhancement, as needed.

3.           Notifies clinic / procedure area, nurse navigator and / or patients to inform them of the authorization denials. Obtains additional clinical information for denials and resubmits to the plan for further consideration.

4.           Collaborates with physicians / fellows and nurses to determine scheduling priorities for access related to overbooks / reschedules. Assures coordination of appointments to facilitate rapid diagnosis and treatment within established timelines.

5.           Uses electronic medical record to schedule appointments and to verify / update patient information and to document appropriate communications. Provides inter-department communications to ensure accurate information and to coordinate appointments.

6.           Communicates with internal and external physicians’ offices to manage referral, and other medical information such as but not inclusive : clinical notes, slides, scans / films and pathology reports / blocks.

7.           Serves as a liaison between patients / families, physicians and nurses among the interdisciplinary teams and departments to collaborate appropriate access for optimum care. Coordinates and communicates care coordination to ensure proper timing and adequate use of appointments.

8.           Establishes relationships with referring providers, patients / families as the point of contact for new patients and responsible for coordinating access for transitioning patients to and from the inpatient and community settings, minimizing delays to care.

Job Accountabilities

1.           Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

2.           Stays abreast of the latest developments, advancements, and trends in the field by attending seminars / workshops, reading professional journals, actively participating in professional organizations, and / or maintaining certification or licensure. Integrates knowledge gained into current work practices.

3.           Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.