REFERRAL SERVICES SUPERVISOR

Job DetailsJob Location: Genesee County - Flint, MI 48502Position 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