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Director, Referral Management
2 weeks ago
Job Summary
We offer remote work opportunities (AK, AZ, CO, DC, FL, HI, ID, KS, MD, MT, NC, NV, NM, OR, SC, TX, UT, VA, WA, WI and WY only)
Under the direction of the Vice President, T-5 Clinical Operations, this position is responsible for the system-wide development, oversight, direction, evaluation and implementation of the Referral Management Program and staff in support of the T-5 TRICARE West Region contract. The Referral Management department processes Referrals and Authorizations (R/A) according to contract standards. In collaboration with T-5 Readiness Integration and Delivery Team (TRIAD) and the Clinical Operations Utilization Management team, the Director develops strategies for achieving annual Referral Management goals and objectives, including input on system configuration and process development.
This position directs referral management, optimization and clinical documentation return processes to meet or exceed contract requirements and corporate objectives. This includes overseeing referral/authorization inventory, Referral Management Specialist (RMS) workload, and directs the Managers of Referral Processing to optimize operational performance of RMS including consultation on performance management, productivity, quality and timeliness of R/As, attendance; quality training and education. This Director also collaborates with TRIAD leadership and other Clinical Operations Directors to achieve TriWest performance standards and other contractual requirements.
Education & Experience
Required:
• Bachelor's Degree in Business Administration, Health Care Administration or related field
• Five years of progressively-responsible management experience
• Five years of clinical or medical management or healthcare management experience
Preferred:
• Knowledge of medical management, including referral management and utilization management
• Prior referral management or claims processing experience
• Master's Degree in Business or related field
• Knowledge of Military Health System and/or TRICARE program
Key Responsibilities
• Direct the overall operational leadership of Referral Management (RM) functions and staff to ensure compliance with contract requirements and adherence to contract deliverables
• Develops strategies for achieving TriWest's referral management objectives.
• Oversee development, implementation, and timely updates to Referral Management department policies, procedures, and guidelines.
• Coordinate with Medical Director to educate and communicate expectations with providers.
• Creates annual referral management strategies, develops performance management metrics, and oversees the management of reporting.
• Work with executive leadership to ensure targets are met for the annual operating plan/financial management.
• Collaborates with Utilization Management Director, TRIAD Directors, network providers, Military Treatment Facilities and TRICARE Regional Office West regarding TriWest's RM program initiatives including submission, review, optimization and return of clinical documentation processes.
• Participates in cross-functional teams to enhance business strategy, process improvement, and use of industry best practices related to referral management.
• Develops and implements training programs for Referral Management department staff and monitors effectiveness of staff training initiatives.
• Ensures an effective performance evaluation system is implemented, including appropriate feedback to staff, motivation, and opportunities for growth and development.
• Contributes to assessment and enhancements of the referral management/medical management systems
• Performs other duties as assigned.
Competencies
Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Knowledge of managed care and/or TRICARE and the Military Health System (MHS)
