Supervisor Health Plan Operations - USFHP

Pacific Medical Centers Corp; Renton (WA); On-site; USD 90,000 - 120,000; Full time

Job summary

Pacific Medical Centers (PacMed) is seeking a leader to organize and direct the Referrals and Referral Support Staff under the USFHP Operations Director. You will ensure accurate data entry and timely processing of authorizations and referrals, while upholding DoD guidelines and contract requirements.

You will set referral policies, monitor compliance, and educate staff on Medicare/TRICARE guidelines. You will participate in budget management with the USFHP leadership team and collaborate with

Qualifications

• 4 years health care referrals experience.
• 2 years supervisory capacity, including Lead role, or 6 months supervisory experience within a healthplan.
• Bachelor's degree in Health Care Administration or Business Administration preferred.

Responsibilities

• Organizes and directs the daily activities and department workflow of the Referrals and Referral Support Staff under the supervision of the Director of USFHP Operations.
• Ensures accurate and timely data entry and processing of authorization and referrals of Pacific Medical Centers' revenues and expenses for Outside e (OPS).
• Assures compliance with DoD and other government agency guidelines and contract requirements.
• Sets Referral policy and monitors compliance to same.
• Monitors Medicare and TRICARE referral guidelines and educates staff in changes.
• Identifies and solves processing issues with outside providers.
• Serves as a member of the US Family Health Plan management team.
• Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.

Skills

Referrals experience

Supervisory experience

Data entry accuracy

Policy compliance

Medicare/TRICARE knowledge

Education

Bachelor's degree in Health Care Administration or Business Administration

Job description

Description

Organizes and directs the daily activities and department workflow of the Referrals and Referral Support Staff under the supervision of the Director of USFHP Operations. Responsibilities include ensuring accurate and timely data entry and processing of authorization and referrals of Pacific Medical Centers' revenues and expenses for Outside e (OPS),. Assures compliance with DoD and other government agency guidelines and contract requirements. Sets Referral policy and monitors compliance to same. Monitors Medicare and TRICARE referral guidelines and educates staff in changes. Identifies and solves processing issues with outside providers. Serves as a member of the US Family Health Plan management team. Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

• 4 years health care referrals experience


• 2 years experience in a supervisory capacity, including Lead role, or 6 months supervisory experience within a healthplan

Preferred Qualifications:

• Bachelor's degree in Health Care Administration or Business Administration

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100‑year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on‑call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with outpatient clinics and primary and specialty care providers in King, Snohomish and Pierce counties. We combine decades of patient-centered care with cutting‑edge technology, first‑class facilities and board‑certified providers.

Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest‑quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Health Services.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.