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Pharmacy Services Specialist (Clinical Programs - Stars) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Pharmacy Services Specialist (Clinical Programs - Stars) and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will utilize specialized pharmacy knowledge and expertise to assist participating pharmacies, members, providers, CalOptima Health departments, health networks and other entities in assuring the efficient, timely and effective provision of pharmaceutical products and services to CalOptima Health members. You will interact with other department staff throughout the organization, as well as external contacts daily. You will be responsible for ongoing public contacts including, but are not limited to, members, individual pharmacies, member advocates, family members, health networks, Public Guardian's Office, Regional Center and other agencies. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Conducts outbound calls to members, pharmacies, and providers in an effort to improve Star measure performance for medication adherence and other Star programs as needed.</li>
<li>Using a pharmacy computer program, retrieves drug-specific technical data and information necessary for the completion of departmental and interdepartmental pharmacy-related functions and operations.</li>
<li>Assists with resolution of provider and member pharmacy issues requiring specialized technical and professional knowledge and expertise, including pharmacy authorizations.</li>
<li>Supports the department with claims disputes between providing pharmacies, the pharmacy claims administrator, CalOptima Health Claims Department and other entities as necessary.</li>
<li>Interprets and articulates Pharmacy Management program policies and procedures to pharmacy providers, other providers, other CalOptima Health staff, external agencies and others as required.</li>
<li>Assists in the processing of pharmaceutical prior authorization and appeals requests as per the CalOptima Health Prior Authorization Guidelines as needed.</li>
<li>Establishes and maintains key contacts both internally and externally to assure appropriate coordination and provision of pharmacy services to CalOptima Health Members.</li>
<li>Accepts referrals from Member Services and work in conjunction with employees from this department to resolve all pharmacy-related member complaints, including those related to the pharmacy authorization process.</li>
<li>Assists pharmacies and health plans in resolving member-specific pharmacy services access issues, removing barriers to access to pharmaceutical services.</li>
<li>Identifies pharmacy-related resources and recommend new procedures, processes or activities that help assure the efficient provision of pharmacy services to members. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Maintains documentation of the Stars adherence program and other Stars program outreach according to the internal guidelines. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High School diploma or equivalent PLUS 1 year of experience as a pharmacy technician required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in a health-related field. </li>
<li>Pharmacy Technician Certification Board (PTCB). </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). </li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>A current, valid, unrestricted California Pharmacy Technician license required.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 301 - $47,840 - $64,584 ($23.00 - $31.0500). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6827274&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is January 13, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6827274" target="_blank">https://jobs.caloptima.org/jobs/pharmacy-services-specialist-clinical-programs-stars-505-city-parkway-west-california-united-states</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-a4c910d8a384f94e85311a8402a7ab2c

Pharmacy Services Specialist (Clinical Programs - Stars)

Grievance Resolution Specialist CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Grievance Resolution Specialist and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Office. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will be responsible for coordinating the grievance and appeal resolution process. You will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions and pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, health networks, third party administrators and regulators. You will collaborate with internal departments such as Customer Service, Provider Relations, Pharmacy and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Maintains adequate information in CalOptima Health's systems; ensures data collection, summarization, integration and reporting, including case creation and management and events/activity tracking.</li>
<li>Gathers pertinent information regarding the grievances and appeals received, including member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.</li>
<li>Coordinates and participates in case discussions with operational experts to result in a final case disposition as needed.</li>
<li>Evaluates case details, proposes recommendations, or makes decisions as applicable, ensures the organization's decision is implemented according to the Grievance and Appeals policies and case resolution.</li>
<li>Develops resolution letters and correspondence to members and providers.</li>
<li>Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals.</li>
<li>Initiates referrals to the Quality Improvement department as applicable and facilitates responses to members according to CalOptima Health policy. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assists with health networks' compliance process.</li>
<li>Meets performance measurement goals for Grievance and Appeals Resolution Services (GARS).</li>
<li>Identifies trends and root cause of issues, proposes solutions, or escalates ongoing issues to management. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 1 year of experience in grievances and appeals, claims, regulatory compliance, customer service or related field required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Associate degree in business, health care administration or related field. </li>
<li>Experience in health care practice standards for both government and commercial plans. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 304 - $53,813 - $80,720 ($25.87 - $38.8077). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6824005&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 31, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6824005" target="_blank">https://jobs.caloptima.org/jobs/grievance-resolution-specialist-505-city-parkway-west-california-united-states-132a29ad-c6dc-41d4-83e2-463f783089a5</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-b91eeef896b1c44e908896c55c9a9cbb

Grievance Resolution Specialist

<h3>Job Description</h3>
Job Description
Home Health and Hospice Referral Specialist
At Aegis Healthcare we are expanding our Home Health &amp; Hospice Nursing Teams and are seeking a dynamic and experienced individual for the role of Home Health and Hospice Referral Specialist who shares our desire to make healthcare better for everyone. 
Why do people LOVE &amp; Feel Supported at Aegis Healthcare?
Our company culture is grounded in our core values of Character, Experience &amp; Trust, which we live every day (you'll know when you meet us). We enrich the lives of those we serve, nurture and support our team's long-term career development, and focus on ensuring everyone feels valued and empowered.

COMPENSATION: $20-$24 / hourly DOE
STATUS: Full - Time
SCHEDULE: Mon-Fri 8am-5pm
LOCATION: 7227 E. Baseline Rd #129 Mesa, AZ 85209

Highlights of working for Aegis Healthcare 
<ul>
<li>Support in your Role: Enjoy comprehensive onboarding and continuous training</li>
<li>Career Longevity: Our average tenure is 5 years.</li>
<li>Meaningful Work: We serve a vulnerable population.</li>
<li>Growth opportunities: With 7 divisions there are paths for advancement.</li>
<li>Employee Experience: Fun Perks, Rewards, and Recognition Programs!</li>
<li>Great Benefits Package: A generous 22 days of PTO + Medical, Dental, Vision, 401(k) + Matching, Life, accident and disability insurance options, and referral bonuses!</li>
</ul>

At Aegis Healthcare our approach to treating patients, our staff, and the community is rooted in our core values of Character, Experience &amp; Trust. To ensure consistently seamless, high-quality care we have developed a continuum of services including Mobile Primary Care, Home Health, Palliative Care, Hospice, Outpatient Therapy, DME, and Medical Transport. By integrating these services, we address the diverse needs of our patients and support our mission to: "Enrich Every Life We Encounter from our employees to our patients and those who love and care for them."

Job Summary
As a Home Health and Hospice Referral Specialist at Aegis Healthcare, you will play a vital role in delivering outstanding home health and end-of-life care to our patients. If you are dedicated to providing exceptional service and eager to challenge yourself daily to positively impact the lives of those we serve, we invite you to join our team. The Home Health and Hospice Referral Specialist is responsible for responding to phone calls and delivering courteous and professional assistance to physicians and patients, Initiating authorization requests for hospice and home health, Verify eligibility and benefits, track referrals to ensure compliance, ensure compliance with federal, state, and local regulations and standards, accept and perform other related duties and responsibilities as required. 
Join Aegis Healthcare today and feel supported and appreciated in a patient-first environment.

Desired Skills &amp; Qualifications
<ul>
<li>Adaptive problem-solving skills</li>
<li>Knowledge of medical terminology and medical insurance terminology</li>
<li>Previous experience in home health and hospice. </li>
<li>Keen attention to detail</li>
<li>Service oriented mindset</li>
<li>Minimum of 2 years of related experience preferred</li>
<li>Valid driver's license, clean driving record, and reliable automobile</li>
<li>Proof of current automobile insurance </li>
<li>Negative TB test</li>
<li>Must be at least (18) years of age</li>
</ul>

Make a Difference with Aegis Healthcare! If you're seeking a supportive environment that values your contributions, apply to join Aegis Healthcare today!

Aegis Healthcare is a part of the Aegis Healthcare Family. Aegis Healthcare Celebrates Diversity and is committed to creating an inclusive environment for all employees, underscored by a Zero Tolerance policy for discrimination. Aegis Healthcare is an equal opportunity employer welcoming applicant without regard to race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity, or any other characteristic protected by law.

 
Ability to pass a criminal background check.

Referral Specialist

<h3>Job Description</h3>
Job DescriptionDescription:

The Referrals Specialist is responsible for managing all incoming referrals for services, ensuring that requests are processed accurately, promptly, and in compliance with agency and state requirements. This role serves as a key liaison between families, service coordinators, and internal departments to support smooth transitions and timely access to services.
Key Responsibilities
Referral Management
Communication &amp; Coordination
<ul>
<li>Communicate with service coordinators, families, and providers to confirm referral details and next steps.</li>
<li>Conduct Customer interviews.</li>
<li>Collaborate with HR, Connections, and leadership to ensure referred Direct Support Professionals (DSPs) and customers are matched effectively.</li>
<li>Provide timely updates on the status of referrals.</li>
</ul>
Compliance &amp; Documentation
<ul>
<li>Ensure referrals are processed in accordance with state and agency guidelines.</li>
<li>Maintain accurate and confidential documentation of all referral activity.</li>
<li>Support audit readiness by ensuring records are complete and up to date.</li>
</ul>
Customer Service
<ul>
<li>Provide clear and compassionate communication to families and customers regarding the referral process.</li>
<li>Resolve questions or issues related to referrals with professionalism.</li>
</ul>
Collaboration
<ul>
<li>Partner with internal teams to anticipate staffing needs related to referrals.</li>
<li>Assist with reporting referral trends and outcomes to support workforce planning and program development.</li>
</ul>
Qualifications
<ul>
<li>High school diploma or equivalent required; Associate’s or Bachelor’s degree in Human Services, Healthcare, or related field preferred.</li>
<li>Previous experience in referrals, scheduling, care coordination, or a related administrative role.</li>
<li>Strong organizational and multitasking skills with attention to detail.</li>
<li>Excellent verbal and written communication abilities.</li>
<li>Ability to work independently and as part of a team in a fast-paced environment.</li>
</ul>
Preferred Skills
<ul>
<li>Experience in healthcare, developmental disability services, or social services setting.</li>
<li>Familiarity with state referral processes, Medicaid Waiver services, or case management systems.</li>
<li>Bilingual skills (English/Spanish) a plus.</li>
</ul>
Work Environment
<ul>
<li>Office-based with potential for hybrid flexibility.</li>
<li>Requires frequent communication with families, providers, and state agencies.</li>
</ul>
Benefits:
<ul>
<li>Dental insurance</li>
<li>Health insurance</li>
<li>Paid time off</li>
<li>Vision insurance</li>
</ul>
Schedule:
<ul>
<li>8 hour shift</li>
<li>Monday to Friday</li>
</ul>
Job Type: Full-time
Benefits:
<ul>
<li>401(k)</li>
<li>401(k) matching</li>
<li>Dental insurance</li>
<li>Employee assistance program</li>
<li>Health insurance</li>
<li>Paid time off</li>
<li>Parental leave</li>
<li>Retirement plan</li>
<li>Vision insurance</li>
</ul>
Work Location: In person
Requirements:

<h3>Job Description</h3>
Job Description
Join a Team That Makes a Difference at Optimus Health Care!
Are you passionate about providing high-quality, patient-centered care? Optimus Health Care the largest provider of primary health care services in Fairfield County is looking for dedicated professionals to join our team! With multiple locations in Bridgeport, Stratford, and Stamford, our mission is to be a lifelong health care partner, dedicated to achieving optimal wellness for the communities we serve.
Join our team-based model of care delivered in a kind and compassionate manner.
We are currently recruiting for a Full Time Referral Specialist for our location in Bridgeport, CT

 The Referral Specialist ensure that referrals are entered in the system for follow up and tracking in accordance with the Referral Process.
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES
<ol>
<li>Oversee the referral coordination to specialty services.</li>
<li>Coordinate appointments for specialty services as requested by primary care physician</li>
<li>Collect proper supporting data for each referral before sending to specialist</li>
<li>Provide reports as needed to the Practice Manager(s)</li>
<li>Be the point of contact for hospitals and specialty offices</li>
<li>Respond to inquiries as to current status of referral by assessing the request and evaluating the circumstances to provide the correct information </li>
<li>Verify prior authorizations with insurance companies via phone, in writing or electronically </li>
<li>Inform patient of appointment date, time and required documentation needed prior to appointment </li>
<li>Provide patient teaching prior to appointment</li>
<li>Review logs on weekly basis to ensure patient kept his/her appointment</li>
<li>Open and review flags regarding consults</li>
<li>Document entry in EMR as a non-billable encounter and enter the specialty appointment in the Referral log</li>
<li>Log any No shows and flag the referring physician for follow up with patient</li>
<li>Direct patient to outside resources when needed as requested by primary care physician</li>
</ol>
Professional positive attitude, vision, understanding of customer service principals, trustworthiness, and excellent interpersonal skills to successfully accomplish tasks necessary to meet high standards of ethical and social responsibility required by this position. 

JOB QUALIFICATIONS/REQUIREMENTS 
 EDUCATION: High School Diploma/GED required. Graduated from an accredited Medical Assistant Program, preferred. Intimate knowledge of language and culture of a sizeable segment of community served by the Health Center. 
EXPERIENCE: 2+ years’ experience in a clinical setting preferred.
LANGUAGE SKILLS: Bilingual preferred – Spanish, Portuguese and/or Haitian-French Creole
 SKILLS: Microsoft Excel and Word. Must have organizational skills, excellent communication skills, and ability to work under pressure.
 REASONING ABILITY: Critical thinking, analytical and problem solving skills
 LICENSURE / CERTIFICATION: None

To be part of our organization, every employee should understand and share in Optimus’ Vision, support our Mission, and live our Values. These values-outstanding, patient-centered, trustworthy, integrity, multicultural, understanding, and supportive -help guide what we do, as individuals and professionals, every day.
<ul>
<li>OHC provides a fun, fast-paced working environment, where our commitment to quality is present in every job function.</li>
<li>Excellent health &amp; welfare benefit </li>
<li>Competitive Compensation</li>
<li>Optimus and its caring and multi-lingual staff proudly serve hundreds of thousands of our neighbors, in a caring patient-centered environment.</li>
</ul>

 Optimus is committed to providing equal employment opportunities to all applicants and employees as protected by applicable federal and/or state law.

<h3>Job Description</h3>
Job DescriptionDescription:
What it means to be a Referral Specialist with Us
We value our families we serve, our communities and our team members. As a Referral Specialist you support a positive patient experience by efficiently processing requests for referrals, prior authorizations, and diagnostic imaging. 
Our Mission
At our offices, we do our best each day to provide high quality, compassionate health care to the families in our communities, treating each child as our own. Our staff and providers strive to make each encounter pleasant and informative while respecting the time and individual needs of our patients and families.
Benefits that Matter!
<ul>
<li>Paid Time Off</li>
<li>Matching 401K</li>
<li>Annual Merit Increases</li>
<li>Mental Health and Counseling Programs</li>
<li>Dental and Orthodontic Coverage</li>
<li>Vision Insurance</li>
<li>Health Care with Low Premiums</li>
<li>Short-term Disability</li>
<li>Access to Virtual Health &amp; Wellness</li>
</ul>
What a day looks like as a Referral Specialist
<ul>
<li>Facilitates outgoing referral requests which include obtaining prior authorization when necessary.</li>
<li>Obtains prior authorization for patient medications.</li>
<li>Schedules and obtains prior authorization for diagnostic imaging requests.</li>
<li>Meets position requirements and performs essential functions.</li>
<li>Completes all mandatory training as required.</li>
<li>Performs other duties as assigned.</li>
</ul>
Requirements:
Qualifications
<ul>
<li>High school diploma or equivalent required; associate or bachelor's degree preferred.</li>
<li>Minimum 1–2 years of credentialing experience, preferably in a pediatric or outpatient healthcare setting.</li>
<li>Knowledge of credentialing processes, insurance payers, and regulatory standards (e.g., CAQH, Medicare, Medicaid).</li>
<li>Strong organizational skills with high attention to detail.</li>
<li>Excellent written and verbal communication skills.</li>
<li>Proficiency with credentialing software, Microsoft Office (Word, Excel, Outlook), and practice management systems.</li>
<li>Ability to work independently and manage multiple deadlines simultaneously.</li>
</ul>
Working Conditions &amp; Physical Requirements
<ul>
<li>Indoor, temperature controlled, smoke free environment.</li>
<li>May at times work under stressful situations.</li>
<li>Handicapped accessible.</li>
</ul>
Pay is detemined by years of experience as well as location(s) of the office. We hope that you find this position as an exciting opportunity and look forward to the potential of speaking with you!

<h3>Job Description</h3>
Job Description
Matthew Walker Comprehensive Health Center has an exciting opportunity available for a skilled, resourceful, and motivated individual who would like to make a difference in the lives of others in helping a non-for-profit organization fulfill its mission to provide quality health care. Reporting to the PCMH Quality Improvement Manager, the Referral Specialist (RS) will be responsible for the following to include, but not limited to:
· Processing patient referrals in a timely manner and responding to general information inquiries
· Answering a high volume of incoming telephone calls from patients, insurance companies and other healthcare providers
· Ensuring ICD-9 and CPT codes are accurate on referral authorizations prior to submitting them to the insurance company
· Responding to information requests from various parties regarding referrals or other pertinent medical requests for patients
· Ensuring referral requests are processed and documented completely and in a timely manner
· Obtaining prior authorization from insurance carriers and following up to ensure referral appointments are kept by patients
· Working cooperatively with insurance companies, patients, center and administrative staff
· Case coordinating for chronic diseases and preventive care for patients
&nbsp;
EDUCATION/EXPERIENCE: 
High School diploma, or equivalent, is required. College degree or higher education level is preferred. The RS should possess stellar customer service, communication, and organizational skills with an acute attention to detail. Knowledge of and the ability to use an automated call distributor telecommunication system is preferred. 
Company DescriptionMatthew Walker Comprehensive Health Center 
<h3>Company Description</h3>
Matthew Walker Comprehensive Health Center

<h3>Job Description</h3>
Job Description
Summary:
The Referral Specialist is Southeastern Integrated Care’s system navigator and point of contact for clients, families, multiple referral sources, payers, and our network of providers assuring clients have direct access to immediate and ongoing care and families, with patients and families having direct access for asking questions and raising concerns. Will assertively assume the advocate role on our clients behalf with the referral source and or payer to ensure approval of the necessary services for the client in a timely fashion. Will serve as the primary communicator with all parties involved in the initial intake/admission process of delivering the ongoing care and recovery of our clients.

Essential Responsibilities:
<ol>
<li>Ensure all methods of referrals are captured in EMR system- (i.e., electronic fax, QR codes, alpha and MCO calendars, walk ins, phone, text, etc. </li>
<li>Collect all referrals to include all enhanced services and residential (adult/youth).</li>
<li>Communicate with integrated care staff about client’s care to include scheduling and delivery of services. </li>
<li>Coordinate/schedule meet/greet with referral sources for youth.</li>
<li>Create client demographics information and upload documentation into the system. </li>
<li>Develop relationships with new and existing clients, partners, and stakeholders.</li>
<li>Attend community events to learn about new trends and build relationships with industry partners.</li>
<li>Communicate with referral source prior to intake and post intake status of visit.</li>
<li>Identify all referral sources, names, numbers, emails inclusive of direct referral, care managers, hospital or DSS, payer source, etc.</li>
<li>Review treatment recommendations of referral source, and Director of clinical Operations</li>
<li>Send out reminder calls to client prior intake</li>
<li>Communicate with primary referral sources if client is a NO SHOW or reschedules. Complete referral feedback form and update contact log weekly.</li>
<li>Gather all referrals fax, email, phone calls, QR code, alpha etc. and reach out to client. </li>
<li>Verify coverage insurance options </li>
<li>Communicate back with all referrals sources outcomes of CCA and treatment recommendations</li>
<li>Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness. The goal is for 95% of all referrals to be admitted to treatment.</li>
<li>Ensure complete and accurate registration, including patient demographic and current insurance information.</li>
<li>Assist clients with problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).</li>
<li>Collaborates with Clinical Operations Director and Referral Manager to assure all referrals are accurately assessed and started in the appropriate level of care in a timely fashion</li>
<li>Other duties as assigned. </li>
</ol>

Education/Experience:
<ul>
<li>Bachelor’s degree in Human Service field with 2 years full-time, accumulated MH/DD/SAS experience with population, OR </li>
<li>Bachelor’s degree in a field other than Human Services with 4 years full-time, accumulated MH/DD/SAS experience with population, OR </li>
<li>An individual who holds a license of Registered Nurse (RN) in North Carolina, and also has 4 years of experience with MH/DD/SAS population. OR </li>
<li>Master’s degree in Human Services field and has 1 year of full–time post-graduate degree accumulated MH/DD/SAS experience with population. </li>
</ul>

Job Qualifications and Skills:
<ul>
<li>QP level credentials to include 2-3 years of experience working in the healthcare field. </li>
<li>Demonstrated leadership skills including excellent oral and written communication skills. </li>
<li>Strong knowledge of healthcare clinical fundamentals, client safety standards, and performance improvement standards. </li>
</ul>
<ul>
<li>Strong client service focus</li>
<li>Strong work ethic</li>
<li>Effective verbal and written communication skills</li>
<li>Comprehensive knowledge of EMR system</li>
<li>Comprehensive knowledge of community resources </li>
<li>Teamwork orientation</li>
<li>Organized and able to manage competing priorities</li>
<li>Good judgment</li>
<li>Resourcefulness in problem solving</li>
<li>Exceptional follow through</li>
<li>Able to take and follow through with delegated tasks and accountability.</li>
</ul>
<ul>
<li>Computer skills and knowledge of applicable software programs to include Microsoft Office and Excel.</li>
<li>Professional demeanor and positive attitude to represent SEIC in the community as well as in the office</li>
<li>Ability to work with diverse populations </li>
<li>Flexibility with schedule </li>
</ul>

Supervisory Responsibilities:
This position does not oversee staff.

Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The work is typically performed in an office environment, with a moderate noise level. 

Physical Demands:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. 
While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; talk and hear; and taste and smell. The employee frequently is required to reach with hands and arms and stoop, kneel, crouch, or crawl. The employee is occasionally required to sit and climb or balance. The employee must be able to lift and/or move up to 20 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Must be able to drive and operate a personal vehicle safely and adhere to all applicable state and traffic laws.

<h3>Job Description</h3>
Job Description

 
Since 1969, MACT Health Board’s mission has been to improve the health status of the American Indian and Alaskan Native population. Our goal is to continue to provide high quality care to our patients throughout a variety of services, including Medical, Behavioral Health, Chiropractic, Dental, Optometry, Massage Therapy, Women’s Health, and more. 
Why MACT Health Care Inc?
Are you searching for a career that offers more than just a paycheck? A career where your professional skills directly empower the health and well-being of our local communities? At MACT Health Board, that’s not just an idea—it’s our daily mission and we invite you to explore our Career Opportunities. You won’t be just another employee; you’ll be a valued member of a team committed to making a difference and we know that taking care of our community starts with taking care of our own. We reward our employees with competitive compensation, benefit options and provide training and advancement opportunities to provide you with the skills to succeed in your future! Our careers offer a unique balance of philanthropic opportunities, cultural preservation and individual value! When you join MACT, you’ll enjoy:
<ul>
<li>Medical, Dental, Vision, and life insurance benefits at no-cost to the employee</li>
<li>403(b) retirement plan, PTO including vacation, sick time, paid holidays and more</li>
<li>Balanced working hours; Monday-Friday 8-5pm. </li>
<li>Student Loan Repayment Program</li>
<li>Direct Student Loan Contributions: Our BenefitED program allows us to make direct quarterly contributions to your student loans to help you pay them off faster</li>
<li>Continuing Education credits: We empower our providers to stay at the top of their field. We offer reimbursement for continuing education and licensure fees.</li>
<li>Competitive Salary of $25.56-$30.10 hourly</li>
</ul>
Who you are:
We are seeking a detail oriented Referral Specialist for a Full role working in a clinical setting. As a member of the health care team, the Referral Specialist is responsible for the referrals, diagnostic orders and surgery coordinating of patients to outside agencies, and the appropriate follow-up of those referrals. The Referral Specialist will:
<ul>
<li>Expedite the delivery of referrals, diagnostics orders and surgery coordination of patients including:
<ul>
<li>Insurance verification and prior authorizations</li>
<li>Transmission of all required medical records to outside facilities</li>
<li>Facilitate appointment scheduling or rescheduling for specialty care</li>
</ul>
</li>
<li>Completion of follow-up on all including:
<ul>
<li>Confirming receipt of referrals</li>
<li>Referral tracking and documentation of activities to include all elements of a referral.</li>
<li>Receipt of medical records and attaching them to the medical chart.</li>
</ul>
</li>
<li>Respond to: telephone calls, faxes and e-mails regarding referrals and provide information with respect and courtesy while being effective and efficient.</li>
<li>Demonstrate ongoing knowledge and documentation of appropriate referral resources, required forms and key contact persons.</li>
<li>Connect and communicate with medical staff such as providers, medical assistants, and other MACT staff at outside facilities, to ensure efficient workflows</li>
</ul>

What you need:
<ul>
<li>High school diploma or equivalent.</li>
<li>Medical Terminology.</li>
<li>Medical Office experience.</li>
<li>One year of experience as a referral clerk or similar type duties working with referral of patients for treatment.</li>
<li>One year of experience as a medical receptionist, medical assistant, or procedure scheduler or satisfactory completion of a medical receptionist/medical assistant training program.</li>
<li> Knowledge of medical computer programs: Next Gen EPM, EHR, i2i Tracks, Epic and other HIE’s. </li>
<li>Knowledge and training in the HIPAA regulations related to patient care documentation, eligibility process and compliance to the regulations.</li>
<li>Good detail analysis, accuracy, oral and written communication, patience and tact required. </li>
</ul>
<ul>
<li>Current BLS/ALS certificate</li>
<li>Must pass Occupational Health Screening.</li>
<li>Must possess a valid form of identification as listed on the U.S. Department of Justice I-9 form, verified using the E Verify system.</li>
<li>Clean DMV driving record and MACT auto insurance driving eligibility (determined by auto insurance carrier).</li>
</ul>

The position requires an awareness and keen appreciation of American Indian traditions, customs, and socioeconomic needs and the ability at all times to meet and deal effectively in contacts with Indian health organizations which requires tact, courtesy, discretion, resourcefulness and good judgment in handling functions of a sensitive nature.
AMERICAN INDIAN PREFERENCE: 
Preference in filling of a vacancy will be given to qualified American Indian applicants in accordance with the Preference Act (Title 25, U.S. Code, Sections 472 &amp; 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment. Other than the aforementioned requirement, the MACT Health Board, Inc. is an Equal Opportunity Employer.

NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT:
MACT Health Board, Inc. is required to implement the Drug-Free Workplace Act of 1988, 45 CFR Part 79, Subpart F. As such it is unlawful for employees to manufacture, distribute, dispense, possess, or use a controlled substance on the job site. Employees who are reasonably suspected of violating this act may be subject to drug testing as a condition of employment. Employer required fitness examinations shall include drug testing as evidence of employee and employer compliance with the Drug-Free Workplace Act.

<h3>Job Description</h3>
Job Description
INTRODUCTION 
Company Overview:
BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes.
 
At BioMatrix the heart of our Inclusion, Diversity, Equity, &amp; Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners.

Schedule &amp; Location:
Varied 8-Hour Schedules Across Eastern, Central, &amp; Pacific Time Zones.
It is anticipated that an incumbent in this role will work onsite in one of the locations noted in the posting. Work location is subject to change based on business needs.

Job Description:
As a key member of the referral services team, a Referral Specialist will serve as the primary contact to a referral source (prescriber, provider, healthcare center, system, and/or practice), the patient for whom the referral is for, and the field-based sales representative associated with the referral source account. In this role, the Referral Specialist will be responsible for navigating a new prescription via a referral from a referral source through the necessary steps to determine whether it can be serviced in the BioMatrix network of pharmacies.
A Referral Specialist will be aligned to a geographic territory of referral sources and corresponding field-based sales team member(s). This role will work closely with data entry, reimbursement, nurse coordination, and pharmacy operations team members supporting various stages of the referral and pharmacy management processes and will understand the referral status and next steps for each referral they are responsible for supporting. The Referral Specialist will build and maintain strong and lasting relationships with key personnel within the referral source environment using effective and timely communication ensuring their patient referrals are managed through service determination in a seamless manner.
QUALIFICATION REQUIREMENTS
<ul>
<li>High school diploma or GED required</li>
<li>Minimum of one (1) year of experience managing patient referral and prescription activities or reimbursement services in infusion or specialty therapies required</li>
<li>Minimum of one (1) year of experience providing customer service in health care setting (patients and/or providers), including meeting high quality standards for services and evaluation of customer satisfaction required</li>
<li>Electronic health medical record or pharmacy patient management experience</li>
<li>Ability to multitask in a fast-paced environment</li>
<li>Proficient in medical or pharmacy terminology, written or verbal</li>
<li>Moderate skills in Microsoft Office (including Word, Excel, PowerPoint, etc.)</li>
<li>Willing to travel up to 5% of the time for business purposes (when necessary to attend meetings, conferences, seminars, etc.)</li>
</ul>
QUALIFICATIONS PREFERRED
<ul>
<li>Bachelor’s degree preferred</li>
<li>Minimum of one (1) year of experience in supporting prescriber, healthcare setting, patient, and field facing communications related to referral or prescription services in infusion or specialty therapies preferred</li>
<li>General understanding of prescription benefits, insurance/payer requirements, and verification processes</li>
<li>General experience working in a health care setting or services environment</li>
<li>General knowledge of infusion therapy process and patient needs</li>
</ul>
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
<ul>
<li>Build relationships with assigned referral sources and associated BioMatrix field representatives through communication and coordination with key personnel responsible for pharmacy referral activities within the healthcare setting</li>
<li>Serve as point of contact to referral source and keep necessary referral source personnel well informed of the status of referrals sent to BioMatrix for service</li>
<li>Follow-up with referral source, patient, and/or caregiver to collect all required information and data sets needed to support the referral process activities (including but not limited to patient demographic, pharmacy/medical benefits, clinical history, and/or prescription details)</li>
<li>Work closely with Reimbursement Specialists and conveys outcomes of benefit investigation activities with patient when it comes to patient out of pocket costs, financial responsibility, and financial assistance options for patient support consideration</li>
<li>Work closely and communicate with Nurse Coordination team for those patients who intend to move forward with service and require in-home nurse care to be scheduled and organized around prescription fulfillment and shipping</li>
<li>Work closely and communicate with Pharmacy operations team members ensuring clinical and fulfillment resources have everything they need to successfully support the on-boarding and on-going fulfillment for a new patient referral/prescription</li>
<li>Produce written documentation representing all provider, patient, caregiver, and/or field team updates and communications in necessary systems of record</li>
<li>Understand referral turn-around time, volume, and workload metrics and goals established by leadership; use goals to effectively organize referral workload and daily activities for successful outreach and completion of referral steps needed to attain service outcomes/determination</li>
<li>Support use of technology and other innovative digital channels for internal and external stakeholder communication as directed by leadership; leverage professional and effective communication skills when utilizing technology for written correspondence with these stakeholders</li>
<li>Have strong understanding of referral and prescription management processes and available services to effectively convey status, outcomes, and next steps to team members as well as referral source, patients, and field resources as expected and needed</li>
</ul>

NON-ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES
<ul>
<li>Ability to prioritize and handle multiple tasks and projects concurrently</li>
<li>General knowledge and understanding of referral profitability and reimbursement options related to referral and patient population being served</li>
<li>Support general administrative activities to navigate patient, provider, and field outreach (i.e. mailings, documentation development, scheduling of meetings/discussions, etc.)</li>
<li>Must have scheduling flexibility and be able to work overtime (from time to time upon request)</li>
<li>Careful attention to detail</li>
<li>Act as a resource to other departments and participate in department meeting and office presentations with your expertise in this area of referral services</li>
<li>Performs related duties as requested by leadership</li>
<li>Participates in quality assurance activities and audits as directed</li>
<li>Overnight travel on occasion by car and airplane</li>
</ul>
KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS
<ul>
<li>Excellent customer service and communication skills (both written and verbal)</li>
<li>Working knowledge of medical terminology</li>
<li>Ability to perform referral related work and tasks in an organized fashion with focus on complete information and time related deadlines</li>
<li>Ability to complete multiple projects with time sensitive deadlines</li>
<li>Ability to manage more than one priority project at a time</li>
<li>Ability to work as part of a team/committee to complete assigned tasks</li>
<li>Ability to exercise independent judgment and at times, work independently</li>
<li>Ability to enlist cooperation of other people and department in completing assigned work and projects</li>
</ul>
<ul>
<li>Ability to actively communicate, inspire and motivate peers, customers, and other stakeholders encountered in the referral services department</li>
<li>Ability to think and act strategically and proactively</li>
<li>Ability to maintain accurate records and prepare reports and correspondence related to the work</li>
</ul>
Communication Skills 
<ul>
<li>Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; demonstrates group presentation skills; actively participates in meetings</li>
<li>Written Communication - Writes clearly and informatively with professional context and direction; edits work for spelling and grammar; varies writing style to meet needs of audience; presents qualitative and quantitative data effectively; able to read and interpret written information effectively.</li>
</ul>
Computer Skills 
<ul>
<li>Become and remain proficient is all technology platforms, applications, and programs necessary to perform referral specialist duties</li>
</ul>
PHYSICAL DEMANDS AND WORK ENVIRONMENT
<ul>
<li>This position requires constant sitting with occasional walking, standing, kneeling or stooping.</li>
</ul>
<ul>
<li>This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.</li>
<li>This position requires constant talking and hearing.</li>
<li>Specific vision abilities required by this job include close vision and the ability to adjust focus.</li>
</ul>
<ul>
<li>This position must occasionally lift and/or move up to 20 pounds</li>
<li>Required to move/lift physical hardware.</li>
</ul>

PHYSICAL DEMANDS 
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If needing a reasonable accommodation within the application process, please contact the BioMatrix People &amp; Culture team at <a href="mailto:Careers@BioMatrixsprx.com" target="_blank">Careers@BioMatrixsprx.com</a> or 954.385.7322 x 1425.
 
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. 

OTHER 
<ul>
<li>Will participate in legal and ethical compliance training each year.</li>
<li>Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures.</li>
<li>Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual.</li>
<li>Will not participate in any conduct considered to be unethical or illegal.</li>
</ul>
 
EXPECTATION FOR ALL EMPLOYEES 
Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins.
GENERAL INFORMATION: 
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.
The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.
Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others).
 
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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