DescriptionSenior Manager of Referrals
Harbor Health
POSITION OVERVIEW
Harbor Health is seeking a Senior Manager of Referrals to lead the referral management function across our payvider model, which integrates a medical group with a health plan. In this role, you will own the end-to-end referral experience, from intake and triage through authorization coordination, scheduling, and closing the loop with primary care and specialty providers. You will build the strategy, team, and processes that connect members to timely, high-quality, in-network care while helping Harbor Health manage the total cost of care.
This role also leads internal referral operations and oversees outsourced referral services, holding vendor partners accountable for contractual obligations, service-level agreements, quality standards, and timely resolution of performance issues. This is a high-visibility leadership role that partners closely with clinical, medical management, network, and operations leaders across Texas.
POSITION DUTIES & RESPONSIBILITIES
Referral Strategy & Operations
- Own the end-to-end referral management program across the medical group and health plan, including intake, triage, authorization coordination, scheduling, tracking, and closing the loop with referring providers.
- Develop and execute policies, workflows, and referral pathways that direct members to high-quality, in-network, and Harbor Health specialty care to improve access, outcomes, and total cost of care.
- Define, monitor, and report key performance indicators, including referral turnaround time, completion rate, network utilization and leakage, authorization approval and denial rates, appointment wait times, and member and provider satisfaction.
Team Leadership
- Lead, coach, and develop a team of managers, supervisors, and referral coordinators across Harbor Health markets.
- Set staffing models, productivity and quality standards, and training programs to ensure consistent, high-performing referral operations.
Cross-Functional Partnership
- Partner with Clinical leadership, Medical Management and Utilization Management, Network and Provider Contracting, Claims, Provider Relations, Care Management, and Member Services to align referral practices with clinical and financial goals.
- Serve as the escalation point for complex referral issues and for provider and member concerns.
Vendor performance and Contract Accountability
- Serve as the primary operational lead for referral vendor relationships, holding vendors accountable for performance against executed contracts, agreed scopes of work, service-level agreements, and quality standards.
- Conduct regular vendor performance reviews using validated data on turnaround times, productivity, accuracy, rework, and escalations. Require documented corrective action plans when expectations are not met, establish deadlines, and verify sustained improvement.
- Identify and escalate recurring performance failures, unresolved issues, and work outside the contracted scope to leadership and the appropriate contracting partners.
Compliance & Quality
- Ensure referral and authorization processes comply with applicable state and federal regulations, accreditation standards, and contractual timeframes.
- Support audits and regulatory reviews, and work with Utilization Management to monitor denial, appeal, and delay trends.
Systems, Process Improvement & Budget
- Evaluate, configure, and optimize referral and authorization workflows within the EHR and utilization management platforms, partnering with IT, Analytics, and external vendors, including TPA partners.
- Identify and implement automation and process improvements that reduce manual work and speed up access to care.
- Manage departmental budget, staffing plans, and vendor performance.
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
- Bachelor's degree in Healthcare Administration, Business, Nursing, or a related field, or equivalent experience is desired; Master's degree preferred.
- 7+ years of healthcare operations experience in referral management, utilization management, prior authorization, care coordination, or patient access.
- 3+ years of people leadership experience, including leading managers or multi-site teams.
- Working knowledge of referral and authorization requirements and applicable state and federal regulations, including Texas utilization review requirements and accreditation standards.
- Experience in a managed care, payvider, integrated delivery, or medical group environment.
- Demonstrated ability to use data and KPIs to drive performance, with proficiency in Excel and reporting or BI tools.
- Experience with EHR and referral or utilization management platforms.
- Strong communication, relationship-building, and change management skills, with the ability to influence clinical and operational leaders.
- Preferred: Clinical licensure (e.g., RN), Lean or Six Sigma training, experience in value-based care, and bilingual English/Spanish skills.
WHAT WE OFFER
- Competitive salary and benefits package
- Generous PTO
- 10 paid holidays
- Medical, Dental, and Vision Insurance
- 401(k) Investment Plan
- Professional development and growth opportunities
- A transparent and unique culture
- Collaborative and dynamic work environment
