Referral Manager

1 month ago

Jacksonville, Florida, United States ChenMed Full time

We're unique. You should be, too.

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Manager, Referrals is a customer-service and leadership-focused position working directly with patients and their families, insurance representatives, doctors and other medical personnel in a dynamic and professional environment to provide the highest level of quality healthcare to all patients.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
  • Provides extraordinary customer service to all internal and external customers (including patients and other Chen Medical team members) at all times.
  • Manages, coaches and provides training to Care Coordinators; ensures they are following company processes. Training can also include other roles as needed.
  • Implements new processes per Referral COE.
  • Conducts monthly Care Coordinator meetings and weekly visits to medical centers.
  • Assists Care Coordinators with solving issues pertaining to referrals.
  • Collaborates with Office Managers to conduct performance evaluations of Referrals Team Members.
  • Addresses / resolves any customer-service issues.
  • Works closely with the Management Team and Administrators in relation to strategic business planning.
  • Manages Referral Approval Process- Use Referral Approval Process Checklist.
    • Communicates alternative/approvals to Referral Coordinator.
    • Follows up with MMD/Specialist/MND if no response after 24hours.
  • Calls and follows up with patients regarding alternatives; uses messaging scripts to speak with patients regarding alternatives.
  • Processes New Patient Referral Exception from Sales Team (if applicable to your market).
  • Prepares and runs referral team meeting- Create agenda for meeting. Gather info from Medical Director /Network Director /Referral Manager.
  • Prepares Referral Team Meeting Minutes and send minutes to Operation Director, Market Medical Director, Market Network Director and Referral COE via email after meetings.
  • Communication with Network Director regards to PPL- Report any errors, concerns or feedback in regard to PPL providers.
  • Analyzes Referral Workflow Report.
  • Generates Weekly Analysis Report and send to Care Coordinators.
  • Builds and maintains effective long-term relationships and higher level of satisfaction with key specialists with support from network director or associate director.
  • Conducts site visits to service providers, resolves issues, educates staff/providers on policies and certifies specialists with support of network director or associate director.
  • Establishes consistent and strong relationships with specialists' provider offices.
  • Collaborates with network leaders to identify network gaps.
  • Identifies root cause of problems and trends; participates in developing solutions.
  • Works with provider's and organization staff to resolve the issue and monitor recurrence.
  • Ensures all elective procedures are entered into HITS prospectively.
  • Works with tier2/tier 3 specialist to make sure our patients are seen working with the Network Director when necessary.
  • Looks for trends and referral patterns -work with Network Director- Example: overutilization and dissatisfaction.
  • Manages Specialist Schedules- Open, close and blocks schedules when advised by Network Director to do so.
  • Covers for Care Coordinator as needed.
  • When needed meet with specialist office and Network Director.
  • Manages time for Care Coordinators with Center Managers.
  • Maintains PPL in conjunction with Network Director.
  • Other duties as assigned and modified at manager's discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
  • Knowledge of products, services, standards, policies and procedures in a healthcare environment
  • Network Management experience/understanding
  • Understanding of cost as it relates to Medicare parts A, B and D
  • Proficient in Microsoft Excel, Outlook and Word
  • Written and oral fluency in English
  • Ability to effectively communicate with employees, patients and other individuals in a professional and courteous manner
  • Ability to pay close attention to detail and to ensure accuracy of reports and data
EDUCATION AND EXPERIENCE CRITERIA:
  • Bachelor's degree preferred; relevant, equivalent experience may be substituted for education on a year-for-year basis
  • Minimum five (5) years' supervisory experience of teams greater than three (3) employees
  • Experience working with Physicians and Directors on a daily basis
  • Experience reviewing data and making decision based of the data
  • Experience working in Medicare managed care environment

We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.

ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.

Current Employee apply HERE

Current Contingent Worker please see job aid HERE to apply

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