Looking for a way to make an impact and help people?
Join PacificSource and help our members access quality, affordable care!
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, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.
The Manager of Referral Services will oversee the referral process, ensuring timely and accurate coordination of healthcare services for our members. This role requires strong leadership, excellent communication skills, and a deep understanding of healthcare systems and insurance policies.

Qualified candidates must be acceptable to the following available work schedule:

• Monday - Friday 8:00am to 5:00pm

Essential Responsibilities:

• Responsible for oversight, management, development, implementation, and communication of department programs.
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Foster strong partnerships with key departments to ensure alignment of business activities.
• Drive interdepartmental process improvements through collaboration and lean methodologies.
• Use visual boards and daily huddles to monitor KPIs and identify areas for continuous improvement.
• Actively participate as a key team member in Manager/Supervisor meetings.
• Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy.
• Lead and mentor UM Coordinator Team Leaders, providing guidance, support, and performance feedback.
• Assist in monitoring, evaluating, and reporting on team performance, focusing on volumes, timelines, accuracy, customer service, and other key performance indicators, including regulatory compliance.
• Monitor quality assurance measures to ensure compliance with company policies and healthcare regulations.
• Work closely with healthcare providers, insurance partners, and internal departments to facilitate seamless referral processes.
• Analyze referral data to identify trends, improve processes, and enhance service delivery.
• Review update referral policies and procedures to align with industry standards and company goals.
• 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.

Supporting Responsibilities:

• Serve as back up to the Director of Referral Services, as needed
• 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 of five (5) years of experience in healthcare management or utilization management required. Prior supervisory or management experience required.
Education, Certificates, Licenses: A Bachelor’s degree in healthcare administration, business administration, or a related field, or equivalent work experience is required.
Knowledge: In-depth understanding of healthcare systems, insurance policies, and regulatory requirements. 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. 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. Excellent verbal and written communication skills.
Competencies
Building Trust
Building a Successful Team
Aligning Performance for Success
Building Partnerships
Customer Focus
Continuous Improvement
Decision Making
Facilitating Change
Leveraging Diversity
Driving for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 15% of the time.
Skills:
Accountable leadership, Collaboration, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking
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

Essential Responsibilities:

• Responsible for oversight, management, development, implementation, and communication of department programs.
• Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Foster strong partnerships with key departments to ensure alignment of business activities.
• Drive interdepartmental process improvements through collaboration and lean methodologies.
• Use visual boards and daily huddles to monitor KPIs and identify areas for continuous improvement.
• Actively participate as a key team member in Manager/Supervisor meetings.
• Actively participate in various strategic and internal committees to disseminate information within the organization and represent company philosophy.
• Lead and mentor UM Coordinator Team Leaders, providing guidance, support, and performance feedback.
• Assist in monitoring, evaluating, and reporting on team performance, focusing on volumes, timelines, accuracy, customer service, and other key performance indicators, including regulatory compliance.
• Monitor quality assurance measures to ensure compliance with company policies and healthcare regulations.
• Work closely with healthcare providers, insurance partners, and internal departments to facilitate seamless referral processes.
• Analyze referral data to identify trends, improve processes, and enhance service delivery.
• Review update referral policies and procedures to align with industry standards and company goals.
• 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

Supporting Responsibilities:

• Serve as back up to the Director of Referral Services, as needed
• 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