Implementation Specialist – Referral Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the discovery process for clients and plan workflows related to central intake, referral reviews, insurance verification, prior authorizations, admission coordination, and concurrent or continued-stay reviews.

• Identify gaps in workflows, clarify responsibilities, and create implementation plans.

• Oversee the configuration and development of workflows within Carefeed’s Referral Management module.

• Determine which activities take place in Carefeed, an electronic health record, or payer portal, and manage the coordination of handoffs.

• Provide role-specific training for teams in central intake, admissions, nursing, MDS, therapy, business office, and corporate sectors.

• Manage the implementation process through the go-live phase and transition, including tracking milestones, action items, barriers, readiness, early adoption, and facilitating handoff to Client Experience and Support.

• Act as an internal subject matter expert on skilled nursing referrals, authorization processes, clinical documentation, and managed care workflows.

• Create training materials, workflow guides, readiness checklists, and standard operating procedures.

• Collaborate with Product, Client Experience, and Support teams to address workflow challenges, relay client feedback, and identify areas for improvement.

• Set clear expectations regarding current functionalities and escalate needs when necessary.

⛳️ Requirements

• A minimum of five years of experience in skilled nursing, short-term rehabilitation, or related post-acute care operations.

• Significant hands-on experience with central intake, prior authorization, and concurrent or continued-stay reviews.

• Proven capability in coordinating referrals, reviewing documentation for accuracy, verifying insurance and benefits, communicating with payers, tracking authorization requirements, and managing time-sensitive follow-ups.

• Strong understanding of clinical documentation, medical necessity, managed care processes, MDS assessments, PDPM, and clinical reimbursement.

• Experience working collaboratively with hospital discharge planners, payer case managers, admissions staff, nursing, therapy, MDS, and business office teams.

• Excellent communication, facilitation, and organizational skills.

• Ability to train others, document workflows, manage competing priorities, and lead teams through process changes.

• Comfortable learning new technologies and assisting others in using them effectively.

• Good judgment in handling confidential resident and client information.

• A background as a Registered Nurse (RN) and/or RAC-CT certification is preferred.

• Familiarity with PointClickCare, MatrixCare, referral management platforms, and payer portals is preferred.

• Experience in leading staff education, process improvement, system implementation, or software adoption is preferred.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• 401(k) plan.

• Paid vacation.

• Sick time.

• Company-paid holidays.

• Opportunities for career growth and professional development.

• An opportunity to join a rapidly growing startup making a meaningful impact in senior care.