Referrals and Medical Records Manager (RN or LPN)

At Claremedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to Claremedica.

ESSENTIAL FUNCTIONS

The Manager of Medical Records and Referrals oversees the integrity, accuracy, and confidentiality of patient health records and referral processes while supporting efficient utilization of healthcare services. This role ensures compliance with HIPAA and other regulatory requirements, leads coordination of medical documentation and referrals and works closely with clinical teams to promote timely, appropriate, and cost-effective care.

DUTIES AND RESPONSIBILITIES

• Oversee the management, storage, and retrieval of electronic and paper medical records.
• Supervise referral workflows to ensure timely processing of incoming and outgoing referrals.
• Support utilization review activities, including ensuring referrals and services meet medical necessity requirements.
• Collaborate with providers and care teams to facilitate accurate clinical documentation and care coordination.
• Ensure strict adherence to HIPAA regulations and internal confidentiality policies.
• Develop and enforce protocols for health information documentation, record retention, utilization review, and release of information.
• Monitor workflow, utilization trends, and performance metrics for medical records and referral operations.
• Train and mentor staff on best practices for documentation, referral processing, and utilization procedures.
• Serve as the point of contact for audits, surveys, and compliance reviews related to medical records, referrals, and utilization.
• Implement and optimize use of electronic medical record (EMR) systems.
• Identify areas for process improvement and lead initiatives to enhance efficiency, accuracy, and appropriateness of care.
• Maintain knowledge of relevant laws, standards, and technology related to health information management and utilization.

SUPERVISORY RESPONSIBILITIES

• This position does have supervisory responsibilities.

• WORKING CONDITIONS

  General office working conditions.

   

  PHYSICAL DEMANDS

  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function. 

   

  While performing the duties of this job, the employee will be required to stand, walk, sit, use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust your focus.  Manual dexterity is required to use desktop computers and peripherals. 

   

  WORK ENVIRONMENT

  The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. 

   

  The noise level in the work environment is usually moderate.

   

  TRAVEL

  Local travel between care centers may be required for coverage.

   

  SAFETY HAZARD OF THE JOB

  Minimal Hazards

   

QUALIFICATIONS/REQUIREMENTS

• Licensed Practical Nurse (LPN) or Registered Nurse (RN) strongly preferred.
• Associate’s or Bachelor’s degree in Nursing, Health Information Management, Healthcare Administration, or related field required.
• 3–5 years of experience in medical records management, referrals coordination, utilization review, or health information systems.
• At least 2 years in a supervisory or management role preferred.
• Strong knowledge of HIPAA and regulatory requirements related to medical records, utilization review, and referrals.
• Proficiency with EMR systems (e.g., eClinicalWorks, Epic, or similar).
• Excellent organizational, analytical, and communication skills.
• Ability to guide teams, resolve workflow issues, and maintain strong coordination with clinical staff.
• High attention to detail and strong problem-solving ability.
• Bilingual in English and Spanish preferred.