This position supervises assigned CareCentrix clinical and non-clinical associates in the department activity surrounding referral coordination. The department activity may involve intake referral processing, provider coordination and authorization and/or completion of the eligibility, benefits and authorization process with the payer. Ensures that services utilized are in compliance with authorization, Utilization Management guidelines and URAC standards as well as CareCentrix policies. Trains new team members and performs ongoing training of existing team. Monitors performance of team and individual members and takes appropriate action to ensure department goals are met. Works under general supervision.
• Supervises all daily team activities and assigns tasks and responsibilities to appropriate team members. Monitors performance and productivity of team and individual members and takes appropriate action to ensure guidelines and goals of the department are met. Completes performance reviews and obtains team leader approval for completion.
• Trains new and existing team members. Participates in staff development, ensuring department activities are consistent with CareCentrix policies and procedures and contractual agreements.
• Assists the Manager in implementing/maintaining standardized operation processes to ensure compliance with CareCentrix policies, legal requirements and regulatory mandates.
• Ensures the confidentiality of patient documentation. Provides guidance to staff in the record documentation process.
• Monitors department reports and provides input for team and individual staff improvement opportunities that are in accordance with department and company goals.
• Sets deadlines and priorities in keeping with Company goals.
• Participates in on-going CareCentrix quality assessment and improvement activities as assigned, and documents information enabling data collection and root cause analysis needed to identify opportunities for improvement.
• Performs all duties in a supervisory role. Interacts with all CareCentrix departments, CareCentrix staff, providers, referral sources and health plans to facilitate communications, answer questions, and resolve problems. Encourages/fosters and environment of teamwork, communication, collaboration and readiness for change.
• Participates in and contributes to performance improvement activities.
• Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Participates in special projects and performs other duties as assigned.
LPN or RN actively licensed in their home state without restrictions is required. Minimum of three-five years’ experience with thorough knowledge of healthcare delivery systems and managed care regulations, utilization management, case management, process improvement, and re-engineering processes, contract terms/stipulations, and government regulations also required. At least one year previous management and leadership experience required. Experience with Utilization Management and Regulatory and Accrediting agency standards preferred.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.