Clinical Referral Specialist

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.

The Clinical Referral Specialist supports our Care Management team by reviewing precertification files, triaging internal referrals, and identifying members eligible for case management. This role ensures timely assignment to Case Managers and supports seamless coordination of care. The ideal candidate is detail-oriented, analytical, and experienced in healthcare data or clinical workflows.

Primary Responsibilities:

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  Review precertification files and triage internal referrals to identify members for case management

  
  


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  Verify eligibility and ensure accurate documentation in care management systems

  
  


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  Use data mining and reporting tools to identify high-risk or eligible members

  
  


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  Assign members to Case Managers based on clinical criteria and caseloads

  
  


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  Track referral activity and maintain compliance with HIPAA and internal protocols

  
  


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  Collaborate with Utilization Management, Claims, and Care Management teams

  
  

Qualifications:

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  Associate’s or Bachelor’s degree in a healthcare-related field

  
  


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  2+ years of experience in a healthcare setting; referral or case management experience preferred

  
  


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  Familiarity with precertification, medical claims, and EHR systems

  
  


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  Strong attention to detail and organizational skills

  
  


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  Proficiency in Microsoft Excel and data tracking tools

  
  


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  Excellent written and verbal communication

  
  


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  Understanding of medical terminology and patient privacy regulations (HIPAA)

  
  

• Comprehensive medical, dental, vision, and life insurance coverage


• 401(k) retirement plan with employer match


• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs)


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  Paid time off (PTO) and disability leave
  
  


• Employee Assistance Program (EAP)

Equal Employment Opportunity: At Point C Health, we know we are better together. We value, respect, and protect the uniqueness each of us brings. Innovation flourishes by including all voices and makes our business—and our society—stronger. Point C Health is an equal opportunity employer and we are committed to providing equal opportunity in all of our employment practices, including selection, hiring, performance management, promotion, transfer, compensation, benefits, education, training, social, and recreational activities to all persons regardless of race, religious creed, color, national origin, ancestry, physical disability, mental disability, genetic information, pregnancy, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, and military and veteran status, or any other protected status protected by local, state or federal law.