Referral Manager

About Pediatrica Health Group Inc.

Every day is a good day to prepare for a healthy tomorrow. Providing children and their families with equitable access to quality pediatric care to build a foundation for a lifetime of optimal health and wellness is what drives our team to deliver its best every day. It’s our purpose.

Offering focused care from tots to teens, our pediatric primary care providers and teams partner with families to foster good health and strong, thriving communities. Second-to-none medical staff and top-tier administrative professionals keep our practices running smoothly and make each patient experience the best we can offer.

Working in partnership with patients, families, and communities who put their trust in us for their care, we hold ourselves accountable to ensure equitable access to care, advocate to create impactful change, and continually learn and progress to create better outcomes and brighter futures. Together, we’re paving the way for kids to develop into healthy young adults. Rooted in these values, we continue to grow and serve. Are you ready to join us?

POSITION SUMMARY:

The Referral Manager is responsible for overseeing all referral operations for the Florida region, ensuring timely, accurate, and efficient referral management across all regional offices. This is a full-time, in-person position based out of the corporate office. This position supervises the regional referral team, provides operational leadership, and works collaboratively with providers, specialists, and administrative staff to ensure exceptional patient care and continuity.

The Referral Manager also leads the implementation and optimization of the LeadingReach platform, manages pediatric prior authorizations, and develops strategies to improve referral processes, reduce referral leakage, and strengthen specialist partnerships.

ESSENTIAL FUNCTIONS

Referral Operations Management

Oversee and manage all patient referrals for Florida regional offices.

Ensure referrals are processed accurately, efficiently, and in compliance with organizational policies and payer requirements.

Coordinate referral operations across all Florida offices to maintain consistency and continuity of care.

Collaborate with providers, office managers, and clinical staff to resolve referral issues and improve workflows.

Team Leadership & Supervision

Supervise, train, coach, and support Regional Referral Coordinators to ensure consistent performance and high-quality service.

Provide oversight, guidance, and operational support to referral staff throughout the region.

LeadingReach Platform Implementation

Lead the implementation, adoption, and ongoing optimization of the LeadingReach referral management platform.

Specialist Network & Referral Leakage

Develop, maintain, and strengthen a narrow network of preferred specialists to improve patient access and coordination of care.

Monitor referral patterns, identify trends, and implement strategies to reduce referral leakage while improving network utilization.

Prior Authorization Management

Manage pediatric prior authorizations, ensuring timely submission, follow-up, and approval in accordance with payer requirements.

Maintain current knowledge of insurance guidelines, referral requirements, and prior authorization processes.

Compliance & Reporting

Track referral metrics and prepare reports to evaluate departmental performance and identify opportunities for improvement.

Ensure compliance with HIPAA, organizational policies, and regulatory standards. Participate in process improvement initiatives and support organizational goals related to patient access and care coordination.

Perform other duties as assigned.

SUCCESS MEASURES

The Referral Manager will be evaluated on:

Timeliness and accuracy of referral processing.

Successful implementation and optimization of the LeadingReach platform.

Reduction in referral leakage.

Performance and development of referral staff.

Timely completion of pediatric prior authorizations.

Consistency of referral operations across all Northeast Florida offices.

Provider and patient satisfaction with referral coordination.

KNOWLEDGE, SKILLS & ABILITIES

Strong leadership and team management abilities.

Excellent organizational and time management skills.

Exceptional verbal and written communication skills.

Ability to manage multiple priorities in a fast-paced healthcare environment.

Strong analytical and problem-solving skills.

Attention to detail and commitment to accuracy.

Strong understanding of insurance referrals, pediatric prior authorizations, and managed care processes.

Knowledge of specialist network management and referral best practices.

Proficiency with Microsoft Office Suite and electronic medical record (EHR) systems.

Ability to build collaborative relationships with providers, specialists, staff, and external partners.

Maintains strict confidentiality and full HIPAA compliance.

EDUCATION & EXPERIENCE

High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.

Experience with referral management systems and electronic health records (EHR); familiarity with LeadingReach preferred.

Prior manager or team-lead experience in a healthcare or referral operations setting preferred.

MANAGERY RESPONSIBILITIES

Directly supervises the Regional Referral Coordinators throughout the Florida region.

WORKING CONDITIONS

General office working conditions across regional referral offices.

PHYSICAL DEMANDS

The physical demands described here are representative of those that an associate must meet to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.