Director of Referral Services
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Job Description
Leading referral management, benefit verification, and prior authorization for LUX Infusion’s specialty infusion services. Improving patient access, reimbursement workflows, and team performance.
Responsibilities:
- Oversee and manage the front-end referral process, including benefit verification and prior authorization for neurology, immunology, transplant, and specialty infusion areas
- Support day-to-day Benefit Verification and Prior Authorization department activities
- Set metrics and goals for Referral Management team members covering referral pull-through, documentation management, benefit verification, and prior authorization processing
- Establish training protocols and evaluate performance against metrics and goals
- Develop corrective action or training plans when needed
- Establish communication procedures for gathering missing or inaccurate information from internal and external stakeholders
- Collaborate with Intake Coordination, Nursing Services, Pharmacy Services, referral operations, and pharmacy operations leadership
- Support accreditation-related processes and data collection
- Review department alignment with service-level agreements, identify trends, and take corrective action
- Support staffing and resource adjustments for referral volumes and organizational growth
- Communicate leadership updates affecting people, processes, and technology
- Serve as an escalation point for issue management and resolution
- Triage work and assign duties to staff
- Perform employee management tasks, including productivity reviews, job description management, performance reviews, disciplinary processes, corrective action, and personnel paperwork
Requirements:
- 5-7 years of experience managing patient referral and prescription activities in infusion or specialty therapies
- 3-5 years of general infusion or specialty therapy reimbursement or payer experience
- 3-5 years of experience supporting prescriber, healthcare setting, patient, and field-facing communications related to referral or prescription services
- 1-3 years of successful management/leadership of department employees
- Strong customer service skills
- High School Diploma or equivalent
- Advanced computer and internet skills, including Microsoft Office
- Knowledge of financial information and reporting
- Willingness to travel up to 5% for business purposes
- 1-3 years of people management experience overseeing pharmacy intake or referral process activities preferred
- Strong knowledge of infusion therapies and patient qualification steps preferred
- Knowledge of payer contracts for infused therapies preferred
- Knowledge of specialty prescription and referral documentation workflows
- Working knowledge of medical/pharmacy terminology
- Knowledge of intake requirements for Medicare, Medicaid, Medicare D, commercial, and pharmacy plans
- Ability to communicate, inspire, and motivate staff
- Strategic and proactive thinking
- Ability to maintain accurate records and prepare reports and correspondence
- Ability to organize and coordinate others' work
- Ability to set priorities and assign work
- Ability to identify process improvements and enact change
- Excellent verbal, written, and communication skills
- Excellent group presentation skills
- Computer skills
- CPR+ knowledge
- Microsoft Excel, Word, and Access Database
- Ability to work overtime and travel overnight occasionally by car and plane
Benefits:
- Purpose-driven leadership work with real patient impact
- Patient-first, clinician-led culture
- Collaborative, supportive teammates
- Opportunity to grow with an organization building something meaningful
- Reasonable accommodations during the application or interview process
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