REFERRAL DEPARTMENT MANAGER Job at COMMUNITY HEALTH OF SOUTH DADE, INC
Position Purpose: The Referral Department Manager oversee the functions of the Referral Department to ensure a smooth and successful operation in maintaining department guidelines and goals. The position provides direct supervision to the Referrals staff.
Position Requirements / Qualifications:
Education/Experience:
Minimum Associate degree required; Bachelor’s preferred. Specialization in Healthcare degree preferred. Must have at least five (5) years managerial experience. Experience working with referrals in a managed care setting. Knowledge of Medicare, Medicaid, Commercial and Marketplace insurances.
Licensure / Certification:
Maintain current CPR certification from the American Heart Association.
Skills / Ability:
Must have excellent communication skills. Ability to work as a team leader and independently. Supervisory skills. Must have knowledge of math, operation of calculator, telephone etiquette, human relation skills and organizational skills. Must be proficient in Microsoft Excel and Word. Must be computer literate. Ability to demonstrate effective oral and written communication skills.
POSITION RESPONSIBILITIES (THIS IS AN EXEMPT POSITION)
Consistently gives attention to details.
Communicates effectively and expresses ideas clearly; actively listens and always follows appropriate channel of communication.
Respects patient privacy.
Consistently greets patients and treats patients with respect.
Follows standard Managed Care Policies and Procedures for all care given.
Supervises Referrals Team.
Performs review/quality audits to ensure Referrals Team stay within department guidelines and policies on referral processing goals.
Travels to multiple sites as required for onsite process evaluation, education and improvement.
Oversee the referral and authorization process in Referrals Department.
Maintain relations with internal and external providers as well as managed care organizations.
Responsible for accurate entry and review of staff’s e-time.
Provide regular updates to Director of Managed Care on key performance as it relates to the Referral Management Department.
Evaluates call volume, incoming referral requests, staffing needs and team productivity.
Quality checks on referrals/authorizations to ensure team is being attentive to patient’s needs and to ensure Patient Satisfaction with the referrals process.
Ensures Referral Coordinator has access to the Managed Care Organization portals in order to process referrals/authorizations
Works collaboratively with the providers and Call Center to assure patients are obtaining their referrals to specialists, diagnostic centers, facilities, etc.
Produces a consistent volume of acceptable work.
Completes assigned tasks in a timely manner.
Assists team members with other tasks to improve patient satisfaction and department workflow.
Patient/provider complaints/issues which require escalation to resolve complaints.
Always able to carry out providers’ orders quickly and accurately to expedite patient care.
Willing to accept other duties not ordinarily assigned to expedite patient care and departmental needs; works as a team player.
Possess knowledge of CHI system, procedures, location of all departments, treatment areas and other patient services.
Adheres to Departmental Policies and Procedures in performing duties and assignment.
Knowledge of contracting guidelines and contracting requirements for referral utilization management.
Demonstrates ability to work with diverse population.
Understands the importance of the new technology in obtaining authorization and is willing to learn new skills.
Conducts teammates first level evaluations, first level 1:1 meeting and coaching sessions.
Provides daily, weekly, monthly, and ad hoc reports to Director of Managed Care.
Possesses general knowledge of managed care environment in coordinating patient care.
Possesses knowledge of referrals/authorization process.
Possesses knowledge of ICD-10 & CPT codes.
Responsible for timecard edits/approvals.
Ordering internal and external supplies.
Develops and maintains referral and order workflows.
Seeks guidance and direction as necessary for the successful completion of job duties.
Consistently combines ethical judgment with technical skills within the policies and legal guidelines of CHI.
Follows written and verbal instructions as directed.
Always attempts to understand staff and co-workers needs and responds accordingly.
Recognizes his/her role in the department and how it relates to the overall function of CHI.
Prioritize patient care using clinical judgment.
Assesses and report medical finding to patient’s provider and/or provider’s team.
Documents medical or other interaction with patient.
Consistently uses time to departmental advantage and assist where needed.
Adapts and is flexible in order to meet changing departmental needs and priorities.
Consistently performs as a self-starter who needs no reminder of his/her duties and/or task, which need to be completed.
Reports to the Director of Managed Care any suggestions for changes in Policies and Procedures that would improve efficiency.
Initiates new ideas and share with team members direct supervisor.
Adjusts workflows to meet departmental and patient care as needed with the approval of Director of Managed Care
Dependable when called upon to assist in departmental needs.
Contributes to and supports company quality initiatives by planning, communicating, and encouraging team and individual contributions towards company quality improvement efforts.
Works collaboratively with clinical leadership and risk management on referral and order work flows.
Consistently maintains work area in a clean and orderly condition.
Observes CHI’s dress code and wears identification badge at all times.
Performs all daily functions in accordance with CHI Policies and Procedures.
Recognizes and evaluates personal strengths and weaknesses; handles personal and professional frustration appropriately.
Adheres to emergency procedures, fire drills, evacuation procedures and internal and external disaster plan.
Relates well and interact with others, regardless of sociological background.
Handles all communications, including telephone information request with courtesy, accuracy and respect for confidentiality; receives information and distributes messages as necessary.
Respect the rights, privacy and property of CHI and others always.
Establishes a good rapport and professional working relationship with all department’s personnel; maintains appropriate interdepartmental communications.
Establishes and maintain professional working relationship with health care providers internally and externally.
Works with referrals team to ensure referrals and orders for imaging, DME, etc. are tracked to closure.
Reports to work on time, as scheduled, and ready to begin work at start of shift.
Never abuses or take advantage of sick time or personal leave days.
Provides proper notification and advance notice for absence or tardiness.
Maintains current license and/or meets continuing education requirements.
Attends in-service training when scheduled.
Utilizes personal protective equipment appropriately.
Follows department and CHI Safety Policies. Reports safety hazards immediately when identified.
Provides direct supervision to the Referral’s staff.
Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.
Performs other work-related duties and responsibilities as directed, assigned or requested.
Ensures referral back logs are kept to a maximum average turnover of 30 days.
Ensures team provides excellent customer service in interactions with patients.
Understands that providers are customers of the department and works with the team to exceed their expectations.
Oversees the processing of e-consults.
Please Note :
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.