Manager, Referral Management
Steward Health Care Network
Steward Health Care Network
This position is responsible for assisting in the design and implementation of the Steward Health Care Network (SHCN) referral management program and Employee Health Plans, across 10 states. Manage office practice relationships to ensure maximum productivity. Manages the day-to-day activities of the Employee Health Plans. Manages Risk Bearing Provider Organization complaints and grievances. Manages all administrative and organizational functions in support of the strategic plan.
* Manages the daily operations of Referral Management, High Tech Radiology Prior Authorizations (HTR) and Employee Health Plans.
* Oversee onboarding of new employees, including ensuring all equipment and appropriate software requested and in place
* Responsible for the day-to-day management of multiple teams, including staff supervision, employee relations and performance management
* Will step in and work with the teams as needed to ensure timeliness of work deadlines
* Collaborates with health plans to insure the transfer of electronic information. Additionally identifies requisite health plan customer training that is essential to a successful referral management program
* Ensures that all referral management policies and procedures are adhered to by all employees
* Manages integrated work team to achieve Key Performance Initiatives (KPI)
* Tracks and reports progress of individual(s) and teams
* Maintains ongoing communication by working with key stakeholders throughout SHCN
* Plans, assesses, and improves operations as identified. Implements improvements through consultation, staff development, and systems improvements. Establishes and manages work groups, planning teams, goals, and tasks as needed
* Manages, educates and assists employees in use of the Employee Health Plans
* Works with other staff in integrating referral management functions in the on-going medical management and case management activities
* Identifies training needs and plans and coordinates staff development and training programs
* Oversees the development and organization of all project documentation according to standards (e.g. pertinent design documents, process flow, budget, file documentation etc). Upon project completion, is responsible for ensuring all documentation and data files are archived according to standards
* Performs other functions as assigned.
REQUIRED KNOWLEDGE & SKILLS:
* Demonstrated ability to plan and implement system-wide programs
* Excellent organizational skills, proven ability to direct complex projects
* Manage program budget
* Excellent verbal and written communication skills
* Demonstrated leadership skills. Ability to role model skills and functions of position and train other staff in all aspects of the role.
* Outstanding interpersonal skills
* Requisite poise, judgment, and trustworthiness to represent SHCN to internal and external groups
* Maintains information in a confidential manner according to policy
* Understand ERISA and HIPAA regulations
* Working knowledge of health plan design
* Experience working with brokers
* Understand state and federal laws as they pertain to health plans
Education: Bachelor's degree in relevant field and/or equivalent clinical work experience.
Experience (Type & Length): At least five years experience in healthcare related management, including supervision of professional and technical staff is essential. Ability to manage team-oriented work is essential. Must be experienced in referral management.
Software/Hardware: MS Office, PowerPoint
Job Reference #: 100024722