Manager, Referral Department

Description : Job Summary :

The Manager of the Referral Department is responsible for overseeing the daily operations and performance of the referral team, which processes and coordinates referrals for specialty care and services for Kaiser Permanente (KP) members.

The department manager will set goals, priorities, and performance standards for the referral and intake teams. This individual is responsible for overseeing initiatives and developing guidelines related to patient experience, quality assurance, training, phone service levels, call resolution, provider and member notification and referral management.

The manager performs management, fiscal, and supervisory responsibilities requiring a high degree of discretion and independent judgement.

The manager will lead or support departmental and interdepartmental process improvements to eliminate waste and improve efficiency.

The manager ensures that the referral process is efficient, accurate, timely, and compliant with KP policies and procedures, and state and federal regulations.

The manager also monitors and analyzes referral data, identifies opportunities for improvement, implements best practices, and evaluates outcomes.

The manager collaborates with other departments, such as Utilization Management, Claims, Quality, and Provider Relations, to ensure a seamless and positive experience for members and providers.

The Manager also provides leadership, guidance, coaching, and development for the referral staff, and fosters a culture of service excellence, teamwork, and accountability.

Essential Responsibilities :

• Manage the daily operations and workflow of the referral team, ensuring that referrals are processed and coordinated according to KP standards and guidelines, as well as regulatory requirements.
• Supervise, train, and evaluate the performance of the referral staff, providing feedback, recognition, and corrective action as needed.

Develop and implement staff development plans and programs to enhance skills, knowledge, and competencies.

Monitor and analyze referral data, such as volume, turnaround time, accuracy, and member satisfaction, using various tools and systems.

Identify trends, issues, and opportunities for improvement, and develop and execute action plans to address them.

• Implement and maintain quality assurance and audit processes to ensure compliance and accuracy of referrals. Ensure that referral policies and procedures are updated and communicated to staff and stakeholders.
• Collaborate with other departments, such as Utilization Management, Claims, Quality, and Provider Relations, to resolve referral-related issues, questions, and escalations.

Establish and maintain positive and productive relationships with internal and external partners, such as physicians, specialists, vendors, and contracted providers.

Participate in departmental and organizational projects, initiatives, and committees related to referral management and service improvement.

Provide input and feedback on referral-related policies, processes, and systems.

Manage the referral budget and resources, ensuring optimal utilization and allocation. Prepare and present reports and presentations on referral performance, issues, and recommendations.

Basic Qualifications :

Experience

• Minimum three (3) years of experience experience in referral management or a related field in a health plan or managed care setting.
• Minimum three (3) years of experience in a workforce management and / call center.
• Minimum two (2) years of supervisory or managerial experience, preferably in a referral department or team.

Education

• Bachelors degree in health administration, business, 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 :

• Knowledge of referral management principles and practices, including regulatory and accreditation standards, such as NCQA, CMS, and DHCS.
• Knowledge of health plan and managed care operations, policies, and procedures, especially related to referral processing and coordination, utilization management, claims, and provider relations.
• Knowledge of medical terminology, codes, and standards, such as CPT, ICD-10, and HCPCS.
• Proficiency in Microsoft Office applications, such as Word, Excel, PowerPoint, and Outlook, as well as other systems and software related to referral management, such as Epic, KP HealthConnect, and ReferralNet.
• Excellent verbal and written communication skills, including the ability to communicate effectively with diverse audiences, such as members, providers, staff, and management.
• Excellent interpersonal and customer service skills, including the ability to build rapport, resolve conflicts, and handle sensitive and confidential information with professionalism and discretion.
• Excellent analytical and problem-solving skills, including the ability to collect, interpret, and present data, identify root causes, and implement solutions.
• Excellent organizational and time management skills, including the ability to prioritize, multitask, and meet deadlines in a fast-paced and dynamic environment.
• Excellent leadership and team-building skills, including the ability to motivate, coach, and develop staff, foster collaboration, and drive performance and results.
• Must be able to work in a Labor / Management Partnership environment.
• Ability to work flexible hours, including evenings, weekends, and holidays, as needed to meet operational needs.
• Ability to travel within the service area, as needed, to visit provider offices, attend meetings, and conduct site visits.

Preferred Qualifications :

• Experience with KP systems and processes preferred.
• Masters degree in health administration, business, or a related field preferred.
30+ days ago