Job Summary: Under the direction of Director of Clinical Services, the referral supervisor directs and supervises all work activity of Omni Family Health (OFH) Referrals Department. The supervisor monitors compliance with policies and procedures to assure the goals and objectives for the appropriate and timely processing of specialty referrals and refills are met.
- Plan, organize, direct, coordinate and supervise the operation of the referrals and refills department.
- Provide oversight of daily operations for department including staffing, training, metrics, performance and reporting
- Coordinate the implementation and maintenance of the Electronic Health Record, Referral and Tracking System; automated phone system and other systems and acts as the liaison with information technology staff and works with staff to resolve any issues.
- Supervise, direct, train and evaluate performance of all referral and refill staff.
- Effective scheduling of staff and workflow to provide optimum coverage with available resources to meet department goals relating to production and quality.
- Answer inquiries, provide information and resolve complaints from the public or other agencies in regards to referrals and refills.
- Review status on Treatment Authorization Request (TARs) and any other authorizations, requirements of Managed Care Organization to assure compliance with health plan programs.
- Shall proficiently track and record reports in the referral systems and electronic health record as they are received.
- Follow-up on pending referrals to include sending certified letters to non-compliant patients.
- Shall cooperatively work with outside agencies to help patients apply for alternate resources when appropriate.
- Review, manage and follow up on tracking system for immunizations, pap smears, and mammogram.
- Promote and believe in OFH mission statement.
- Ability to relate to the public regardless of racial, ethnic and economic status
- Investigate difficult cases and is the lead contact for patients or providers’ inquiries/concerns in obtaining appropriate care for the patient.
- Interview, hire, perform disciplinary action and performance evaluations for employees.
- Maintain inventory of supplies and equipment for the Referral Department.
- Perform other related duties as assigned or requested.
- HIPAA compliance – responsible for maintaining abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information confidential.
- Compliance – Ensure compliance with all local, state and federal regulations.
- QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT – Required learning and using the Electronic Health Records and Practice Electronic System and its components. As required by the job functions and highlighted in the Policies and Procedures.
- All employees will participate in Patient Centered Health Home Model at Omni Family Health.
- Enhances professional growth and development through particiapation in educational programs, current literature,, in-service meetings, and workshops.
- Encourages creative thinking, problem solving, and empowerment as part of the facility management group to improve teamwork and morale.
Qualifications, Education, and Experience:
- Preferred Bachelor’s Degree in healthcare related field.
- Must have supervisory experience of at least two years and knowledge of supervisory practices and principles, including work planning, scheduling, review and evaluation and employee training and discipline.
- Knowledge of applicable laws, rules and regulations, including MediCal and HIPPA.
- Thorough understanding of medical terminology, payor sources, insurance and program requirements.
- Ability to communicate and maintain an effective working relationship with staff and providers.
- Must be a self-starter and be able to function with little or no supervision.
- Must obtain a valid Driver’s License and Proof of insurance.
Responsible To: Director of Clinical Services
Classification: Full or Part Time Position, Exempt