Supervisor, Referral Services

The Supervisor, Referral Services is responsible for the management of the Referral Services staff to ensure timely processing of incoming authorizations, referrals, and review of post-service issues such as claims. Will also have regulatory oversight responsibilities for annual audits and participation in QI activities/committees.

Qualifications

REQUIRED EXPERIENCE AND SKILLS:

1. Minimum of three years recent acute clinical experience required
2. Minimum of three years utilization review/manage care experience
3. Prior supervisory experience with the ability to manage a large team of diverse employees with differing job descriptions
4. Managed care experience in medical management desirable, preferably in an HMO or IPA setting
5. Experience with ICD-9, CPT and HCPCS codes preferred
6. Must possess the ability to read health plan guidelines, understand the statistics of this department, contracts, claims and customer service principles
7. Advanced practice certification, ARNP or Masters prepared, with certifications applicable to position (CCM, CDMS, CRC, CRRN, CHON, and CPUR)
8. Working knowledge of utilization management, reimbursement, medical necessity criteria including InterQual
9. Knowledge of managed care concepts, Medicare/Medi-Cal Guidelines.
10. Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access systems. Ability to navigate through various software programs with instruction.
11. Requires current California RN license with 5+ years in Utilization Management

Additional Information

If you have the experience & qualifications, please respond with your resume in a Word document.