Referral Nurse (LPN)

Referral Nurse (LPN)

Department: Nursing
Reports To: Director of Nursing

Position Summary

The Referral Nurse (LPN) coordinates patient referrals to specialty providers and ancillary services to ensure timely access to medically necessary care. This position works closely with providers, patients, specialists, hospitals, and insurance companies to obtain referrals, authorizations, and appointments while promoting continuity of care. The Referral Nurse also provides clinical support within HCPSC clinics as needed and serves as a resource for patients throughout the referral process.

Essential Duties and Responsibilities

·         Coordinate and process referrals to specialists, diagnostic testing, and ancillary services in accordance with HCPSC policies and provider orders.

·         Obtain prior authorizations and insurance approvals required for specialty services, procedures, and diagnostic testing.

·         Schedule referral appointments and communicate appointment details, preparation instructions, and follow-up information to patients.

·         Collaborate with providers, specialists, hospitals, and insurance companies to facilitate timely referral processing and continuity of care.

·         Track referral status to ensure appointments are completed and consultation reports are received and incorporated into the patient’s Electronic Health Record (EHR).

·         Verify and update patient demographic, insurance, and referral information to ensure accurate processing.

·         Maintain accurate documentation of referrals, authorizations, communications, and patient follow-up activities within the Electronic Health Record (EHR).

·         Respond to patient questions regarding referrals, authorizations, and specialty appointments while providing excellent customer service.

·         Assist with resolving referral, insurance, and billing issues related to specialty care.

·         Provide clinical support within HCPSC medical clinics during staffing shortages or operational needs, as directed.

·         Maintain patient confidentiality and protect health information in accordance with HIPAA and organizational policies.

·         Participate in required trainings, staff meetings, and quality improvement initiatives.

·         Perform other duties as assigned.

Education & Experience

·         Current South Carolina Licensed Practical Nurse (LPN) license in good standing required.

·         Current Basic Life Support (BLS) certification required.

·         Minimum of two (2) years of nursing experience in a physician practice, outpatient clinic, or healthcare setting preferred.

·         Experience with referrals, prior authorizations, insurance verification, or care coordination preferred.

·         Experience working in a Federally Qualified Health Center (FQHC) or community health center preferred.

·         Experience using Electronic Health Record (EHR) systems preferred.

Knowledge, Skills, and Abilities

·         Knowledge of referral coordination, prior authorization processes, insurance verification, and medical terminology.

·         Knowledge of HIPAA regulations and the ability to maintain the confidentiality, security, and integrity of patient information.

·         Strong organizational, communication, and customer service skills with the ability to manage multiple priorities.

·         Proficiency in Microsoft Office and Electronic Health Record (EHR) systems.

·         Ability to collaborate effectively with providers, specialists, hospitals, insurance companies, and interdisciplinary healthcare teams.

·         Ability to exercise sound judgment, solve problems effectively, and maintain accurate documentation in a fast-paced healthcare environment.

Health Care Partners of South Carolina is an Equal Opportunity Employer. We are committed to fostering a diverse and inclusive workplace and encourage qualified applicants from all backgrounds to apply.