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.

REQUIRED EXPERIENCE AND SKILLS:

• Minimum of three years recent acute clinical experience required

• Minimum of three years utilization review/manage care experience

• Prior supervisory experience with the ability to manage a large team of diverse employees with differing job descriptions

• Managed care experience in medical management desirable, preferably in an HMO or IPA setting

• Experience with ICD-9, CPT and HCPCS codes preferred

• Must possess the ability to read health plan guidelines, understand the statistics of this department, contracts, claims and customer service principles

• Advanced practice certification, ARNP or Masters prepared, with certifications applicable to position (CCM, CDMS, CRC, CRRN, CHON, and CPUR)

• Working knowledge of utilization management, reimbursement, medical necessity criteria including InterQual

• Knowledge of managed care concepts, Medicare/Medi-Cal Guidelines.

• Basic computer skills including Outlook, WORD, Microsoft suite and VPN or other remote access systems. Ability to navigate through various software programs with instruction.

• Requires current California RN license with 5+ years in Utilization Management

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

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