Supervisor, Referrals

We're committed to bringing passion and customer focus to the business.

Job Description:

We are excited to welcome a dedicated professional referral supervisor to our team! This role is all about providing exceptional supervision, management, and oversight of the member advocacy, and referral, validation, and authorizations process. The Supervisor will ensure quality of work is performed by the referrals team. If you have a strong background in supervision and/or management of customer service and healthcare, and you thrive in a dynamic environment, we would love to hear from you!

Job location

McAllen, Tx – Call Center

Objectives

• Streamline care coordination between members and providers.
• Support the referral team in prioritizing work.
• Utilize community resources effectively to meet member needs.
• Enhance appropriate utilization of services and preferred providers for medical care.
• Maintain high standards of confidentiality and compliance with HIPAA regulations.

Job Responsibilities

• Organizes and oversees the schedules and work of the referral team.
• Ensure efficiency by departmental goals.
• Conducts performance evaluations that are timely and constructive while providing training and documentation for the productivity and efficiency of the department.
• Handles discipline and termination of employees as needed and following company policy.
• Coordinate between employees and members to troubleshoot and address any challenging referrals, and advocate for members.
• Accurately supervises and supports work prioritization.
• Identify, research, and utilize community resources appropriately while benchmarking best practices and networking for patient-related resolutions.
• Validate intake assessments and communicate with members to identify needs and achieve desired outcomes.
• Master systems to obtain data and information for specialized projects.
• Develop strong relationships with members and advocate on their behalf with providers, specialists, and community agencies.
• Handles escalated members' concerns and those with high acuity and high-intensity needs.
• Act as the data owner for referral OKRs/KPIs.
• Manages expertise in data to support the referral department.
• Provides recommendations to leadership to streamline roles and responsibilities.
• Participate in meetings and present information as needed.
• Report on outcomes related to Referral Coordinator initiatives, member-related data, and employee performance.
• Run daily referral reports for the team to distribute workload and maintain results.
• Conduct periodic validations of previously authorized ongoing care for tracking purposes.
• Assists with the preparation of budgets and works on cost reduction and cost efficiency initiatives.
• Maintains appropriate production and employee records.
• Ensures that team and staff comply with company policies and safety standards.
• Coordinates with human resources to respond to employee concerns or complaints.
• Performs other related duties as required.

Knowledge, Skills, and Abilities

• Supervisory skills with problem-solving-oriented focus.
• Excellent managerial skills.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.

• Ability to anticipate and solve problems with a high sense of urgency.
• Knowledge of local community programs, government, and social agencies.
• Ability to receive constructive feedback and take initiative to obtain training.
• Ability to multitask and prioritize multiple projects.
• Great customer service skills.
• Teamwork skills.
• Self-motivated and self-managed.
• Detail-oriented.
• Advanced skills in Microsoft Office Suite.
• Skilled in the use of computer and EMR systems.
• Knowledge of web resources and database software.

Qualifications

• High school diploma or equivalent required.
• Five years of related experience, with at least two years of supervisory experience, required.
• 1-3 years of experience working in a healthcare setting.
• Previous medical referral/healthcare coordination/call center experience (preferred).
• Bilingual; fluent in English and Spanish (preferred).
• BA/BS in business, management, or healthcare (preferred).
• Knowledge of ICD-10 and CPT-4 coding, and medical terminology.

Work Environment

• Depending upon the area assigned 100% clinical or office setting in a clinical environment.
• Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements

• Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs.
• Close vision and ability to adjust focus.
• Must be able to work efficiently under pressure.

Additional Information

• Other duties as assigned by the supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.

We look forward to welcoming you to our team and working together to make a positive impact on our members' lives!

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!