Job Description
Job Location: Genesee County - Flint, MI 48502
Position Type: Full Time
-
- -
- - -
Position Summary
- -
- -
- - - This position is responsible for the daily supervision of the Referral Department. The Supervisor will oversee the organization and coordination of activities associated with patient referrals to ensure that patients obtain health care follow up services with clinics, partnering specialty providers, and community organizations resulting in continuity of care for all patients in a timely manner. The Supervisor will develop and maintain workflow systems, analyze outcomes and departmental progress compared to policy and strategic goals, and creatively solve problems utilizing data and department personnel. The Supervisor will ensure all Department employees understand and adhere to the mission of the organization and understand that employment is also contingent upon adherence to HCHN policies and procedures, HIPAA, Joint Commission standards, OSHA standards, and other safety and health related codes and laws.
- -
-
-
- -
- - - Duties &
- - - Responsibilities
- -
- -
- - - General Responsibilities
- - - • Coordinates the responsibilities of Referrals Specialists and Referral Navigators, ensuring referrals are processed for patients once received from the provider.
- - - • Ensures departmental adherence to the organization’s policies (with priority focus on “Provision of Care – Referral Process”) to be implemented consistently and within stated policy timelines.
- - - • Responsible for ensuring all organization specialty referral and authorization functions are met.
- - - • Facilitates collaboration between referral specialists, clinical referral navigators, providers, operations managers, and medical assistants supporting patient linkage to primary and specialty care services.
- - - • Functions as the liaison between referral sources, managed care representatives, patients, and physicians concerning the network of care overseen by primary care providers at HCHN.
- - - • Responsible for weekly auditing and reporting from the Referral Tracking tool and Azara Referral Dashboards.
- - - • Under the direction of the CAO, assists in the development and implementation of goals and objectives to ensure high-quality, cost-effective operations associated with Department responsibilities.
- - - • Regularly advises the CAO on issues regarding referral functions associated with patient care, including staffing, data collection, appointment systems, and customer satisfaction.
- - - • Maintains up-to-date information of referral clinical guidelines, active providers, appropriate use criteria, and private insurance requirements necessary for pre-certification or outside referral as well as other related information.
- - - • Leads the process of researching the patient managed care organization plan to ensure that referrals are made to the proper provider within the patient’s network.
- - - • Responsible for department adherence to guidelines as determined by each managed care plan specific to their referral process and obtaining appropriate authorizations. This includes:
- -
- - - - Obtaining appropriate demographic identification for each managed care plan and utilizing specific forms/data entry as specified.
- - - - Preparing authorizations with patient diagnosis and requests from the primary care physician and any other need information.
- -
- - - • Oversees the process of ensuring necessary information is obtained for the patients’ charts when tracking referrals.
- - - • Responsible for supervising submission of authorization forms for referrals prior to the patient’s appointment time.
- - - • Weekly responsible for ensuring all referral staff maintain and update their individual referral specialist logs.
- - - • Maintains department-wide documentation for every referral completed, ensuring that required data is updated in the EMR timely.
- - - • Ensures documentation is completed on all attempts made to secure patient consults, in collaboration with Medical Records, as well as information regarding patients’ compliance with attending scheduled specialty referral appointments to close the referral loop.
- - - • Ensures department-wide documentation relative to if patients kept specialist appointments or if a second appointment is needed.
- - - • For missed appointments, ensures the referral specialists will schedule new appointments.
- - - • Answers questions from HCHN patients requesting referral assistance and/or from referring physicians to ensure efficient patient referral processes and complete patient information. Professionally handles patient complaints.
- - - • Responsible for the training of new Referral Specialists.
- - - • Administers personnel policies and procedures, interviews and supports selection of new hires, ensures orientation for on-the-job responsibilities, resolves conflicts, and evaluates employee performance.
- - - • Completes performance appraisals for subordinates in a timely manner.
- - - • Attend seminars or training sessions as appropriate for new managed care programs and/or for updates on existing programs.
- - - • Other duties as assigned.
- -
-
-
- - -
- - -
-
Qualifications
-
- -
- - -
- - - Job
- - - Requirements
- -
- -
- - - Education and/or Experience
- - - Required:
- -
- - - - High School Diploma or G.E.D.
- - - - Proven experience working with a managed care referral, prior authorization, or consultation process.
- - - - Proven knowledge of Medicaid and managed care insurance programs.
- - - - Minimum of three (3) years’ experience as clinical support in a health care setting.
- - - - Experience working within an Electronic Medical Record (EHR) system.
- -
- - -
Qualifications
- - - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- -
- - - - Ability to maintain confidentiality in all matters.
- - - - Ability to exercise good judgment in assessing situations and make decisions.
- - - - Capability to interface and maintain effective relationships with all programs, agencies, and intra-agency personnel.
- - - - Ability to communicate effectively verbally and in writing.
- - - - Flexible, with the ability to work independently and with minimal guidance.
- - - - Possess excellent interpersonal and customer service skills to effectively and tactfully collaborate with a diverse group of patients, staff, customers, and community groups.
- - - - Meets professional behavior expectations.
- - - - Ability to provide excellent customer service skills.
- - - - Ability to use the telephone and computer.
- - - - Ability to work with the public.
- - - - Ability to meet all attendance and punctuality requirements to ensure proper coverage and quality service.
- - - - Ability to resolve interpersonal and professional conflicts appropriately.
- - - - Professional and appropriate dress as required by the position.
- - - - General computer proficiency.
- - - - Takes pride in job performance as evident in compliance with job responsibilities.
- - - - Assumes responsibility for work performance and is able to be self-directed.
- - - - Participates in staff meetings, trainings, and committees.
- -
- -
-
-
- -
- - - Language
- - - Skills
- -
- -
- -
- - - - Ability to communicate effectively with diverse populations.
- -
- -
-
-
- -
- - - 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
- -
- - - - While performing the duties of this job, the employee is regularly required to talk or hear.
- - - - The employee frequently is required to stand, walk, sit; use hands to handle or feel; reach with hands and arms; and stoop, kneel, or crouch.
- - - - The employee must lift and/or move up to 25 pounds.
- - - - Specific vision requirements include the ability to see at close range.
- - - - At times, may require more than 40 hours per week to perform the essential duties of the position.
- - - - Fine hand manipulation (keyboarding).
- - - - Travel between sites using own vehicle.
- -
- -
-
-
- -
- - - Work Environment
- -
- -
- - - The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- -
- - - - Internal office space.
- - - - The noise level in the work environment is usually moderate.
- - - - May be exposed to communicable diseases.
