Job Summary:The Referral Operations Manager works in conjunction with the management team to support the work and goals of the Outside Referral Department (ORD). The Manager is responsible for executing strategic plans and policies that will result in timely, accurate, compliant and cost-effective processing of referrals. This position is responsible for developing and implementing plans and policies for high customer service and continuous quality improvement in all areas of the referral operations.Essential Responsibilities:
Manages the efforts of the Outside Referral Department (ORD) organization.
Manages appropriate workload balancing and staffing levels to achieve performance targets, meet regulatory requirements, and deliver high quality customer service.
Guides activities performed by supervisor including establishing priorities, defining performance goals and expectations, and reviewing progress and accomplishments.
Responsible for selecting, developing, and deploying staff in the most effective manner to meet assigned objectives.
Uses efficient and cost-effective approaches to integrate technology into the workplace and improve program effectiveness.
Communicates information effectively, translating financial data into meaningful information that supports business decision-making
Has budget accountability and applies understanding of operational and financial performance to anticipate and meet departmental needs
Partners with Affiliated Provider Services and Network Development & Administration in managing relationships with external providers.
Collaborates and partners with various departments such as clinical operations, claims operations, cost containment, finance, and contracting, to coordinate overlapping responsibilities, resolve issues, and develop and implement cross-departmental procedures that will result in quality customer service
Represents the department in discussions regarding referrals processing operations; identify impact, develop and implement appropriate process and systems changes.
Works with quality audit teams to evaluate findings from referral audits and address corrective action plans.
Ensures standard reports and analytical methods are used to monitor trends and results as well as identify potential operational issues or opportunities.
Prepares regular evaluations of performance (e.g., turn-around-time, productivity, quality ratings)
Facilitates the ongoing learning, educational programs, and professional development of staff through training, work assignments, increased responsibility, mentoring, and regular performance feedback.
Takes corrective action, as appropriate, to assure issues are identified, discussed, documented and resolved.
Basic Qualifications:
Experience
Minimum four (4) years of management experience in health care or insurance business environment. OR
Minimum two (2) years of management experience in health care or insurance business environment. AND
Minimum four (4) years process and/or project management, consulting, or related business experience with knowledge of process management/improvement methodologies.
Education
Bachelors degree in health care management/administration, business administration, economics, finance, accounting, or related field OR four (4) years of experience in a directly related field. High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Ability to adapt to constantly shifting priorities in managing a wide range of projects; team player, tactful and diplomatic.
Excellent interpersonal skills required and ability to interact professionally with culturally diverse individuals.
Strong project management, leadership, and presentation skills.
User knowledge of computer systems/applications including Microsoft office suite (i.e. Excel, Word, PowerPoint, Visio).
Ability to work independently with a variety of internal and external personnel at all organization levels.
Strong financial and analytical skills with experience analyzing medical expenses and utilization.
Good knowledge of industry standard codes (ICD-10, CPT, Revenue, Modifier, etc.).
Understanding of contract terms and payment methodologies.
Knowledge of applicable federal and state laws and regulations related to the healthcare industry.
Excellent skills in complex analytic problem solving, project management and group processes.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Experienced developing education and training programs.
Knowledge of KP HealthConnect/EPIC or other HealthCare systems
Knowledge in one of the following: quantitative analysis, financial analysis, healthcare economics, information systems, organizational development, health care delivery systems, project management or new business development.
Understanding of compliance, systems and processes relating to medical service referrals and authorizations.
Masters degree in business administration, economics, finance, accounting, or related field
COMPANY: KAISERTITLE: Manager, Outside Referral Department (ORD)LOCATION: Los Angeles, CaliforniaREQNUMBER: 1321570External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
