Referral and Patient Care Manager

Job overview

The Referral and Patient Care Manager role is hybrid in North Palm Beach, FL. Compensation is $55,000–$70,000 per year. The position supports the Clinical Operations / Utilization Management department. The manager leads referral processing, utilization review, and case management operations to support timely, clinically appropriate, and compliant decisions. By guiding staff, applying evidence-based criteria, and coordinating with providers and internal teams, the role supports appropriate healthcare resource use and quality outcomes.

What you'll do

• Supervise, train, and mentor referral coordinators, case managers, and utilization review staff
• manage daily workflow, staffing, and productivity
• maintain department policies and procedures
• oversee use of MCG and other evidence-based criteria
• ensure medical necessity determinations are documented and meet regulatory and accreditation standards
• serve as a clinical resource for complex cases, peer-to-peer reviews, and appeals
• oversee transitions of care, discharge planning, and service coordination
• monitor caseloads
• participate in audits and quality reviews
• support denial and appeal processes
• coordinate with medical directors, provider relations, quality, and claims teams
• report performance and utilization trends to leadership.

What we're looking for

Skills & competencies

referral and patient care manager

hybrid

north palm beach fl

clinical operations

utilization management

case management

referral processing

prior authorization

mcg guidelines

medical necessity

rn license required

$55k–$70k/year

Work arrangement

• Weekend coverage required

Why this role

An active, unrestricted clinical license is required; Registered Nurse (RN) is strongly preferred, while other clinical licensure may be considered. Occasional availability for urgent clinical reviews outside standard hours may be required.

About the employer

PCC MEDICAL HOLDINGS LLC is hiring for this role. Industry: All Other Miscellaneous Ambulatory Health Care Services. Sector: 62.