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Sutter HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing healthcare referrals and understanding managed care processes, while effectively communicating and maintaining confidentiality in a fast-paced environment.
Highest-signal resume keywords
Healthcare AdministrationReferral ManagementHealth Information ManagementInsurance Authorization ProcessHIPAA Requirements
About the role
Key responsibilities & impact- Review confidential clinical information
- Provide personalized referrals to individuals or physicians/clinics requiring specialty services
- Facilitate referrals to appropriate Sutter facilities, programs, affiliated specialists, and aligned specialists
- Assess referral requests and determine the appropriate level and provider of care
- Manage and reprioritize activities and projects to meet deadlines
- Provide feedback and input to improve workflows and processes
- Work effectively in a dynamic, fast-paced environment with changing business priorities
Requirements
What you’ll need- Bachelor's degree in Business and/or Healthcare Administration, or related field, or equivalent education/experience
- Equivalent experience accepted in lieu of the required degree or diploma
- 2 years progressively responsible experience in healthcare/medical insurance, Health Information Management, Admitting/Patient Access, Patient Financial Services, and/or Case Management as typically acquired in three or more years
- 2 years' experience in an acute and/or non-acute healthcare setting
- 2 years' experience working with computerized systems and/or electronic medical record
- Working knowledge of managed care requirements and processes
- Knowledge of system, affiliate and community resources, and third-party payers (e.g., PPO, HMO, Medicare, insurance plans)
- Knowledge of insurance authorization process and HIPPA requirements
- Familiarity with medical and managed care terminologies
- Understanding of disease process to assess referral requests and appropriate level/provider of care required
- Ability to define issues, collect data, establish facts and draw valid conclusions
- Ability to communicate verbally and in writing, and present information to a variety of audiences
- Organizational skills to manage or reprioritize activities and projects to meet deadlines
- Ability to maintain effective working relationships
- Ability to use essential applications and/or databases associated with the role's duties
- Ability to maintain and work discreetly with confidential and sensitive information
Benefits
Comp & perks- Comprehensive benefits package for eligible positions
- Total rewards program
- Equal opportunity employer
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Information ReviewPatient AccessCase ManagementElectronic Medical RecordManaged Care KnowledgeData Collection and AnalysisDisease Process Understanding
Soft Skills
Effective CommunicationOrganizational SkillsRelationship Management
Tools & Technologies
Computerized SystemsDatabases
Industry Keywords
Healthcare SettingThird-Party PayersInsurance PlansPPOHMOMedicare