Reliant Medical Group is seeking a Ancillary, Applicantion & Business Intelligence Manager to join our excited and innovative organization!
Full Time: 40
Hours: Monday - Friday 8:30AM - 5:00PM
No nights or weekends
Responsible for the review and direction of outgoing tertiary referrals as well as assistance in the review of other outgoing referrals and other related duties.
Reviews tertiary referrals for the organization members before pending to multi-payor groups and assists physician in directing member to appropriate tertiary facility/provider.
For approved tertiary referrals, monitors member’s utilization and coordinates communication between tertiary provider and patient’s primary care physician to ensure efficient quality care for patient.
Assists in direction of other outgoing referrals for the organization members.
Performs data entry and necessary research for authorization process.
Develops and maintains preferred provider directories to assist providers in making referrals for their patients.
Communicates both by telephone and on-site with providers, staff, patients and payor representatives to facilitate pre-authorization process.
Strictly observes the organization’s policy regarding confidentiality of patient information.
Functions independently and generally establishes own work plan and priorities, using and/ or modifying established procedures, to assure completion of assigned work in conformance with established departmental policies and standards: problems lacking clear precedent to be reviewed with Manager prior to taking action.
Ensures compliance with various payers’ policies and procedures in determining medical necessity for medical procedures, medications, treatments and hospitalizations.
Collaborates with care management regarding inpatient hospitalizations and high risk patients for appropriate care coordination.
Reviews medical and surgical procedures using industry standards for medical necessity
Complies with health and safety requirements and with regulatory agencies such as DPH, etc.
Complies with established departmental policies, procedures, and objectives.
Enhances professional growth and development through educational programs, seminars, etc.
Attends a variety of meetings, conferences, and seminars as required or directed.
Performs other similar and related duties as required or directed.
Regular, reliable and predicable attendance is required.
Please note some time will be spent in the Worcester as well as the Southboro offices.