Job Summary:
The Registered Nurse (RN) on the Referral Coordination Team (RCT) is responsible for coordinating and clinically reviewing consults and referrals to ensure the delivery of appropriate, timely, and high-quality care. The RN functions as a clinical liaison between patients, internal and external providers, and administrative staff, ensuring the consult and referral process is comprehensive, effective, and aligned with clinical guidelines.

Key Responsibilities:

• Conduct clinical review of consults and referral requests for completeness, appropriateness, and utilization in accordance with established standards and guidelines.
• Determine disposition of care, including whether services should be rendered internally or through community providers, based on utilization criteria.
• Review and document incoming medical records, maintaining communication with ordering providers and primary care teams.
• Coordinate care across multiple entities, including patients, external providers, internal clinicians, and administrative staff to ensure accurate and timely processing of referrals and authorizations.
• Triage specialty consults to assess clinical appropriateness and completeness according to national coordination standards.
• Engage patients via telephone to discuss healthcare options, enabling informed decisions on where and how to receive specialty care when community care eligibility criteria are met.
• Serve as a clinical resource to multidisciplinary teams, including physicians, licensed independent practitioners, social workers, and support staff across multiple regions.
• Assist in the development and revision of consult templates in collaboration with clinical application coordinators.
• Act as a liaison throughout the consult process, supporting both internal clinical staff and community care partners.
• Build and maintain collaborative relationships with specialty care providers and utilize established triage tools to support informed decision-making and care coordination.

Qualifications:

• Active, unrestricted RN license.
• Clinical experience in care coordination, case management, or referral management preferred.
• Strong knowledge of clinical triage, utilization review, and community care guidelines.
• Excellent communication and interpersonal skills to work collaboratively with diverse healthcare teams and patient populations.
• Proficiency in reviewing and interpreting medical records and consult documentation.