Job Description

Location: Steward Health Care Network
Posted Date: 6/21/2022

Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.

The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.

Position Purpose: This position will be a key member of Steward Health Care Network (SHCN), working within the SHCN Concierge Referral Management team (SHCN RM). The position works predominantly within one market in order to be most effective in identifying the appropriate provider given understanding of the local geography and landscape.

  • Performs the daily operations of Concierge Referral Management identified market. Serves as a back-up for additional markets, as needed
  • Creates and processes referrals and Radiology prior authorizations, consisting of, but not limited to:
    • Receives incoming requests from practices and consumers via eFax, phone, or workflow tool
    • Obtains authorization from insurance plan if the payer requires
    • Verifies eligibility and coverage
    • Finds a highly aligned provider to engage for a specialist or facility consult using the highly aligned provider listing
    • Schedules the appointment with the specialist by contacting the specialist practice or scheduling directly in the electronic medical record
    • Notifies PCP / referring practice of the date, time, and specialist the patient will see
    • Confirms availability with patient and assists in scheduling the patient with the specialist
    • Engages with Medical Directors, as necessary, to process referrals
  • Uses a referral data tool to manage and retain care within the Steward network whenever appropriate
  • Under the direction of the Medical Director and Manager, communicates plan dispositions for out-of-network health care services to members and PCP offices
  • Ensures accurate and timely processing of all requests
  • Communicates with physician practices and patients as needed
  • Confirms appointments and/or referrals with physician practices and consumers
  • Assures that all necessary documentation occurs in a timely manner
  • Achieves established performance targets
  • Meets established quality expectations, e.g., confidentiality, accuracy, customer service, and professionalism
  • Supports other departmental team members to ensure turnaround time expectations are met
  • Communicates important information to team members
  • Contributes to team efforts to improve workflow and efficiency
  • Provides Outstanding Customer Service, going the “extra mile” to assure that customer expectations are met
  • Assists with other projects within the department on an "as needed" basis
  • Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment
  • Commits to recognize and respect cultural diversity for all customers (internal and external).
  • Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages, utilizing interpreters when needed
  • Performs other duties as assigned

Education / Experience / Other Requirements

Education:

  • Associate degree or equivalent amount of education and experience; Bachelor’s degree preferred

Years of Experience:

  • At least 2-4 years’ experience in a healthcare-related field. Medical office experience strongly preferred

Specialized Knowledge:

  • Fluency in a foreign language desirable; particularly Spanish, Russian, Portuguese, Haitian Creole, or Vietnamese
  • Exceptional Customer Service
  • Strong communication and interpersonal skills; particularly in intense situations
  • Ability to meet deadlines in a high-pressure environment
  • Knowledge of managed care concepts and medical terminology
  • Ability to multi-task and work with multiple software applications
  • Knowledge of insurance, medical office practice, and/or referral processing
  • Demonstrated ability to process insurance referrals and/or schedule physician appointments
  • Excellent organizational skills and attention to detail
  • Demonstrated understanding of the need for patient confidentiality in a HIPAA-compliant environment
  • Demonstrated ability to work independently and as part of a team
  • Knowledge of 3rd party payers

This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.

Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.


Additional Information

Steward Health Care Network is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment – with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience:

  1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
  2. A stringent cleaning policy has been implemented throughout our facilities.
  3. A strictly controlled visitor and masking policy is required for patient and colleague safety.

You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

Apply Online