Clinical Referral Specialist

Job Summary

A company is looking for a Clinical Referral Specialist to support their Care Management team.

Key Responsibilities:

• Review precertification files and triage internal referrals to identify members for case management
• Verify eligibility and ensure accurate documentation in care management systems
• Use data mining and reporting tools to identify high-risk or eligible members

Required Qualifications:

• Associate's or Bachelor's degree in a healthcare-related field
• 2+ years of experience in a healthcare setting; referral or case management experience preferred
• Familiarity with precertification, medical claims, and EHR systems
• Proficiency in Microsoft Excel and data tracking tools
• Understanding of medical terminology and patient privacy regulations (HIPAA)