What are the responsibilities and job description for the Director, Referral Services position at PacificSource Health Plans?
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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
The Director of Referral Services will lead, develop, and oversee the operations of the non-clinical referral services team within the Utilization Management (UM) department. This role requires strategic leadership, operational oversight, and collaboration with multidisciplinary teams to enhance operational efficiency, reduce costs and improve member outcomes.
Essential Responsibilities:
- Lead, mentor, and develop a high-performing team of non-clinical referral services staff, including Team Leads, Coordinators, and Support Specialists.
- Monitor, evaluate, and report on team performance, focusing on volumes, timelines, accuracy, customer service, and other key performance indicators, including regulatory compliance. Responsible monitoring employee engagement scores across the team.
- Develop and execute a strategic vision for referral services aligned with organizational goals, including cost containment, operational efficiency, and improved member outcomes.
- Lead initiatives to transition from reactive to proactive referral processes, focusing on streamlining workflows, reducing duplication, and enhancing automation.
- Collaborate with senior leadership to align referral management operations with broader UM and care management strategies
- Develop and manage the annual budget for referral services, ensuring alignment with the organization’s financial objectives.
- Identify cost-saving opportunities by analyzing referral patterns, reducing unnecessary referrals, and eliminating inefficiencies.
- Implement technology solutions to automate manual processes, minimize administrative costs, and optimize staffing levels.
- Monitor financial performance and operational metrics, adjusting strategies to meet or exceed budget targets and performance goals.
- Develop and implement policies and procedures that align with organizational goals and regulatory requirements.
- Utilize data analytics to drive decision-making and operational efficiencies.
- Standardize systems, processes, and policies across the organization and continuously seek ways to enhance service quality and process efficiency for all Line of Business as well as external stake holders.
- Ensure internal departmental awareness, inclusion, and deployment of relevant Centers for Medicare and Medicaid (CMMS), Oregon Health Authority (OHA), National Committee for Quality Assurance (NCQA, and other relevant regulatory body rules and guidelines.
- Serve as the liaison across PacificSource departments to optimize service delivery and information sharing. Participate in management planning, Request for Proposals (Medicare/Medicaid applicable oversight), and complete annual reports as required by states we serve.
- Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy.
- Foster partnerships and build strong relationships with key internal and external stakeholders. Work collaboratively with the Utilization Management Director to ensure seamless transitions across the continuum and to establish best practice strategies for managing members across LOBs.
- Responsible for oversight, management, development, implementation, and communication of department programs. Development and monitoring of department budgets.
Supporting Responsibilities:
- Actively participate as a key team member in Corporate and Department Manager meetings.
- Participate in and support project teams led by other departments and provide necessary input to support the goals of colleagues.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum seven (7) years of experience in healthcare management or utilization management required. Minimum three (3) years leadership experience required.
Work Experience: Bachelor’s degree in healthcare administration, business administration, or a related field required. Master’s degree preferred.
Knowledge: Proficient in healthcare data analytics tools and electronic health record systems. Extensive knowledge of medical procedures, ICD-10/CPT codes, health insurance, and CMMS/State of Oregon benefits. Experienced in report evaluation, quality improvement, and using Microsoft Office, SharePoint, and medical management platforms. Able to work independently, manage staff, and handle member interactions in various care situations. Skilled in building relationships with stakeholders and excellent analytical, communication, and interpersonal skills. Proven ability to manage staff and build effective relationships with internal and external stakeholders. Excellent verbal and written communication skills.
Competencies
Authenticity
Building Organizational Talent
Coaching and Developing Others
Compelling Communication
Customer Focus
Empowerment/Delegation
Emotional Intelligence
Leading Change
Managing Conflict
Operational Decision Making
Passion for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.
Skills:
Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic Planning
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
