Job Description

Location: Steward Health Care Network
Posted Date: 5/18/2023

Position Purpose: This position will be a key member of Steward Health Care Network (SHCN), working within SHCN Referral Management (SHCN RM) team and in coordination and collaboration with SHCN Social Services Team.

Position Summary:

  • Use of a referral management platform to match the consumer with the most appropriate behavioral health provider based on location and behavioral health and social determinants of health (SDOH) care needs
  • Facilitate referral to Mass Health designated Community Partners (CP), facilitate necessary documentation and communication between SHCN and CP
  • Content expert in insurer requirements for BH services ensuring the appropriate approvals and prior authorizations are complete
  • Content expert in SDOH resource database
  • Identifying and referring of patients to appropriate social services organizations and community resources
  • Referral creation and processing with appropriate plan as required
  • Serve as liaison between members of specific health plans, primary care providers and specialists to coordinate behavioral health referrals and assist with ensuring members access to needed behavioral health care services consistent with their plan benefits
  • Facilitate communication between CP and SHCN providers and Care Management teams to ensure timely, accurate and comprehensive care coordination
  • Identification and referral to SHCN Social Services and Care Management based on established protocols
  • Assist in the scheduling process between consumer and behavioral health provider when appropriate
  • Ensure accurate and timely processing of all requests.
    • Receives incoming requests from physician practices, consumers and other providers.
    • Verifies eligibility and coverage
    • Obtains insurance referrals as needed
    • Assists the consumer with BH provider selection
    • Schedules patient appointments by contacting BH practices Communicates with physician practices, behavioral health providers and consumers as needed.
    • Confirms appointments and/or referrals with BH practices and consumers.
    • Assures that all necessary documentation occurs in a timely manner.
    • Achieves established performance targets.
    • Meets established quality expectations e.g. confidentiality, accuracy, customer service and professionalism.
  • Teamwork
    • Supports other departmental team members to assure turnaround time expectations are met.
    • Communicates important information to team members and supervisors.
    • Communicates need for additional support in managing referrals as part of escalation process.
    • Contributes to team efforts to improve workflow and efficiency.
  • Provide Outstanding Customer Service
    • Goes the ‘extra mile’ to assure that consumer expectations are met.
  • Assists with other projects within the department on an "as needed" basis.
  • Demonstrates respect and regard for the dignity of all consumers, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
    • Commits to recognize and respect cultural diversity for all customers (internal and external).
    • Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
  • Performs other duties as assigned.


  • Associates degree. Bachelors degree preferred.

Years of Experience:

  • At least 1-3 years experience in behavioral healthcare related field or public health..

Specialized Knowledge:

  • Strong verbal and written communication and interpersonal skills
  • Proficient with Microsoft Office programs
  • Ability to meet deadlines in high-pressure environment
  • Demonstrates effective interpersonal skills in intense situations
  • Demonstrates verbal de-escalation skills
  • Ability to follow protocols in behavioral health emergency situations over the phone
  • Knowledge of managed care concepts and behavioral health terminology
  • Ability to multitask and work with multiple software applications
  • Knowledge of insurance, medical office practice and/or referral processing.
  • Demonstrated ability to process insurance referrals and/or schedule physician appointments.
  • Excellent organizational skills and attention to detail.
  • Customer service focused.
  • Demonstrated understanding of the need for patient confidentiality in a HIPAA-compliant environment.
  • Self-motivated
  • Demonstrated ability to work independently and as part of a team.
  • Reliability
  • Knowledge of 3rd party payers.
  • Fluency in a foreign language desirable e.g. Spanish, Russian, Portuguese, Haitian Creole and Vietnamese

Application Instructions

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