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GENERAL INFORMATION

Location:

Tacoma, WA

Salary:

DOE-up to $72,000 annually

Date posted:

Oct 07 2010

Date expires:

Open Until Filled

EMPLOYER

Company:

Puyallup Tribal Health Authority
See all Puyallup Tribal Health Authority Jobs

Employer type:

Non-profit

JOB DESCRIPTION

General Functions:
Manage the daily operations of the Referral Services Department to ensure compliance with applicable regulations. Analyze, evaluate, and report utilization of referred services.

Essential Functions:
• Develops, implements, and manages the systems and processes to provide referral services to PTHA patients.
• Supervise day-to-day activities and work assignments of the Referral Services staff, provide on-going training and performance evaluations annually or as needed.
• Understands and ensures compliance with applicable federal regulations, contractual obligations and organizational policies pertaining to the authorization of referred services.
• Prepares statistical and narrative reports as requested by departmental Director or Administrative staff on utilization patterns, expenditures by revenue stream, demographics of service delivery and trending patterns quarterly.
• Establishes and maintains a reporting system for monitoring the use of outside providers and tracking and estimating the expected costs of referrals.
• Responsible for monitoring referral patterns and making recommendation on strategies to contain costs, improve access, and ensure quality of care.
• Makes recommendations for ongoing and future service delivery options and ensures the implementation of applicable practice guidelines and referral criteria established by the Clinical Director.
• Serves as clinical liaison between PTHA internal providers and outside providers who provide services to PTHA patients.
• Establish and maintain positive relationships with outside providers who provide services to PTHA patients and assist in negotiating access to care in targeted areas.
• Develops annual operating budget and manages department expenditures to meet approved budget.
• Participates as a member of the Clinical Review Board for the resolution of complex cases, appeals, operational changes, and insurance issues.
• Remains knowledgeable in ICD-9 Diagnostic coding, CPT procedural coding, and length of stay guidelines.
• Department expert in Indian Health Services RPMS system and NextGen EPM/EMR with regard to referrals processing.

Minimum Requirements:
BSN degree with current WA state Registered Nurse (RN) license required. One year experience in utilization management and review or one year experience in managed care in a hospital, health care, or managed care setting. Three (3) years supervisory experience. Proficient with MS Outlook and MS Office Suite (Word, Excel, PowerPoint and Access) or similar applications. Experience and/or ability to work with an Electronic Health Records System

TO APPLY:
A PTHA employment application is required (resume optional). Applications are available in the Human Resource Department or on the PTHA website. Completed applications must be submitted to the Human Resource Department by 5:00 pm on the closing date. Indian hiring preference by law.


PTHA-Human Resource Department
Kwawachee Counseling Center, bldg #4, 1st Floor
2209 E 32nd St
Tacoma, WA 98404

Phone (253) 593-0232 ext 516
Fax (253) 593-3479
Email: hr@eptha.com
Website: www.eptha.com

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