The manager will have administrative duties responsibilities, such as hiring, performance management, conducting meetings, collaborating with staff to ensure referral procedures are being followed This position will require continuous process improvement to ensure all standards of compliance are maintained.

Duties:

1. . Demonstrates clear knowledge of standards, procedures and protocols

2. Ensure team is meeting goals and objectives through effective hiring, training, performance management, coaching, counseling and retention efforts.

3. Leads the referral staff and activities involved in coordinating referrals from physicians to hospitals and specialists.

4. .Develops and implements standardized work flows

5. Prepares statistical data reports for senior management.

6. Identifies key performance metrics related to referral network utilization in alignment with desired program outcomes and communicates ,educates and hold team accountable for outcomes.

7. Receives inquiries from providers, patients, and HMO's and addresses in timely manner

8. Participates in all referral and UM audits with our delegated healthplans. Collaborates with the team to resolve opportunities from each audit to attain compliance with specific standards and processes.

9. Develops and implements the review proces using MCG criteria to ensure compliance

10. Establishes special and/or ongoing projects including assignment of personnel, project goals, and time frames for division.

11. . Runs reports, interpret, analyze data, evaluate and audit performance of the referral dept to identify opportunities to increase productivity and accuracy.

12. Ensures complex referral requests for nurses, physicians, or committee review are rountinely completed completion, verifying eligibility, chart availability, and conducting benefit research.

13. Collaborates with other departments regarding opprotunities for improvement.

14. Participates regularly in committees such as PCC, Claims, and Manager meetings.

15. Develops and implements policies and procedures for department.

16. Provides expertise and assistance in assigned areas.

17. Strives to resolve any departmental administrative problems and keeps lines of communication with staff open.

18. Maintains professional affiliations and enhances professional growth and development to keep current in the latest trends in collections management.

19. .

20. Maintains strict confidentiality

21. Other duties as assigned.

Education and Experience: BA/BS, MA or extensive related experience preferred. Previous experience with referral management workflows, systems and leading a centralized referral center required. . 3-5 years of supervisory experience leading a complex dept. Knowledge of Managed Care Principles highly recommended. Must be able to communicate effectively in both written and verbal forms.

Computer Skills Experience in working with Electronic Health Records (EHR),Ability to use Microsoft word for basic correspondence. Proficient in excel, Power point, and outlook. Previous experience working with MCG criteria and EZCAP software.

Leadership Responsibilities: Leads, mentors assigned staff. Responsible for overall direction, coordination, and evaluation of the department. Carries out leadership responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Administrative Duties: Exercise discretion and independent judgment.

Work Environment: Office setting, well lighted and ventilated.

Physical Demands: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 25 lbs. Close vision and ability to adjust focus.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.