Providence Manager Referral Operations in Portland, Oregon
Providence is calling a Manager Referral Operations - Pmg Referral Operations (1.0 FTE, Days) to Providence Office Park Portland in Portland , OR. Anticipated work schedule will be between 7:00am to 5:30pm Monday - Friday
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We are seeking a Manager Referral Operations - Pmg Referral Operations that will be responsible for the planning, development, implementation, maintenance, and evaluation of the referral utilization programs designed to meet the needs of the patients served by Providence Medical Group. This position is accountable for monitoring performance against standards set in the annual Quality Plan, delegation agreements, and service level agreements with specialty providers, and Clinical Programs. This position also works collaboratively with PMG shared services when new initiatives include referral or authorization components.
The Referral Operations Manager also has responsibility for the daily operations of the PMG Referral Operations Department, specifically the work of the Medical Management and Referral Coordinators. Departmental responsibilities include processing of referral requests and preparation of requests requiring additional medical review, securing insurance authorization for high-cost diagnostic imaging studies, and compliance with insurance carrier requirements to secure the highest benefit for requested services.
This position promotes a supportive, team-based environment within the Referral Operations Department and builds and maintains strong relationships with other internal and external contacts.
In this position you will have the following responsibilities:
Plan, develop, implement, evaluate and improves the Referral Operations Program
Work in conjunction with the CMOs, the department Director and Area Medical Directors to analyze and trend resource utilization
Adjust program dependent upon those data and panel composition
Provide a programmatic infrastructure that allows flexibility in focus, yet consistent in medical necessity decision-making
Plan, manage and monitor the Referral Operation Program activities to assure that required referrals and authorizations are in place within established timeframes with minimal referral/authorization turnaround time
Work with the Physician/Hospital Billing staff, identifying opportunities to streamline processes to meet changing insurance requirements
Provide a supportive, team-based environment that facilitates group decision making and employee empowerment
Supervise staff performance and developmental training including ongoing performance assessment and the development and monitoring of improvement plans according to PHS guidelines
Evaluate performance and initiates personnel actions according to PHS guidelines such as hiring, merit increases, periodic reviews, promotions, transfers between teams, and performance management
Develop and analyze production reports to assess or project staffing levels for budgetary purposes
Develop and maintain policies and procedures in support of the Referral Operations Program, staying current with changes in Epic, and assures compliance with delegation agreements, Medical Home, Meaningful Use, and other regulatory requirements and communicates new processes to end users
Develop and maintain training materials and workflows for the Medical Management and Referral Coordinators
Maintain health plan information needed to process referrals in a readily retrievable format in order for the medical management coordinators to process work correctly and in a timely manner
Prepare and present monthly, quarterly and annual performance reports on the Referral Operations Programs
Prepare and present the annual evaluation of the program and services. Important opportunities for improvement are selected and strong interventions are implemented to improve performance
Solicit feedback regarding the service performance of the programs
Analyze customer satisfaction data for opportunities for improvement and acts upon that information
Investigate and respond to complaints regarding department performance or service
Promote effective provider and member communication and maintains positive interpersonal relationships
Manage 'Virtual Consult' process to ensure communication is timely between primary and specialty care providers and referral/authorization processing is expedited as needed
Is the key contact with the Epic team to ensure accuracy of the Provider Table (add missing providers, status changes, referral preference list updates, etc.), and facilitates the work group to promote optimization of the referral module automating referral processing to the extent possible
Engage with PMG shared support services to optimize collaboration and efficiency, including new initiatives that include referral/authorization components
Work cross-regionally with Physician Services to identify and adopt best practices
Support transitions of care for patients when providers move or leave PMG, including working directly with clinics to transfer referrals as needed to new provider
Establish and meet departmental goals, objectives and action plans. Establishes and meets program budget goals
Conduct regular departmental staff meetings to communicate organizational changes and developments
Facilitate team development, team function, and problem solving
Required qualifications for this position includes:
Master's Degree in Business Administration, Accounting, -OR- Healthcare related field
Bachelor's Degree Plus four (4) years management/industry experience
Associate's Degree Plus six (6) years management/industry experience -OR- eight (8) years related management/industry experience
Two (2) years of Relevant management/supervisory experience in healthcare or related field
Experience in high volume processing with use of contemporary electronic processing systems
Expansive experience using the Epic Referral Application (processing and reporting)
Experience in a medical information production environment
Preferred qualifications for this position includes:
Accounting background, and customer service experience
Experience in project/program management and using process improvement (Lean, RPI, PDSA, etc.) techniques, including performance analysis
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Req ID: 298307