Sutter Health Specialty Network Referral Consultant - Specialty Network Services (Full Time - Days) in Sacramento, California
The Specialty Network Referral Consultant:
Provides personalized and effective customer service inthe management of complex referrals for patients requiring high levelspecialty services.
Reviews confidential clinical information anddetermines if requested/required services are available within the entireSutter Medical Network.
Works simultaneously with senior leaders, executivelevel teams and data analysts to develop and maintain strong referralpatterns in an ever changing competitive market.
Is responsible for creating smooth and efficientreferral workflows for external sources, leveraging evolving technologyand interoperability tools such as DIRECT, CareEverywhere andSutterLink.
Provides concierge service to our clinicians andpatients by working with multidisciplinary teams, providing streamlineaccess and minimizing confusion with a one-stop shop approach.
Additional informationabout the position:
Exempt level - High performer required.
70% Referral concierge service
10% Relationship management between referring entitiesand providers
10% Department development and process improvements
10% Quality and Subject Matter Expert Consultation andtraining (supporting SutterLink, Direct Secure Messaging andCareEverywhere technology).
This role does NOT perform authorizations.
Starting annual salary of $57,450 plus a comprehensivebenefits package.
Who is an IdealCandidate?
High performing driven individual.
High level relationship management experience.
Experience with public speaking - provide trainingand/or deliver presentations.
Looking for a challenge.
Critical thinker, able to "connect the dots".
Problem solver, has forethought of potential issues.
Has the ability to handle constant interruptions, butstay on task.
Has a thorough understanding of disease process,anatomy, and physiology.
To learn more about the Specialty Network Referral Service team:
To learn more about the Sutter Health Network in which you would support:
MINIMUM POSITION REQUIREMENTS:
Associate's degree or equivalent of 10+ years experience in the field required.
Completion of course(s) in Medical Terminology required.
Bachelor's degree in the healthcare field preferred.
A minimum of 3 years of previous experience in a hospital, physician office or case management setting required.
A minimum of 3 years of previous experience in working with database systems and telephone call center required.
A minimum of 3 years previous insurance experience required.
Skills and Knowledge:
Proficient/Advanced knowledge of community resources, Sutter Health resources, third party payers ( i.e., PPO, HMO, and Medicare Risk insurance plans) is required.
Working in-depth advanced knowledge of managed care requirements and processes is required.
Advanced working knowledge of all state Medicare and Medi-Cal guidelines and process is highly preferred.
Advanced knowledge of ICD-10 and CPT Coding preferred.
Demonstrate advanced knowledge of insurance authorization process required.
Advanced knowledge of patient registration process highly preferred.
Intermediate PC proficiency in word processing and database software applications required.
Effectively interacts with individuals from all levels of the organization.
Intermediate medical and managed care terminology required.
Advanced ability to organize and work independently with minimal direction in a fast paced environment required.
Advanced proficient understanding of patient flows, processes and advanced medical and technical terminology and practices required.
Advanced thorough understanding of disease process, anatomy, and physiology as necessary to assess referral requests and appropriate level/provider of care required.
Ability to communicate effectively, oral and written, with individuals possessing varying levels of comprehension required.
Organization: Sutter Valley Hospital
Employee Status: Regular
Employee Referral Bonus: No
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: Other
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.