Referral Authorization Modernization Program Implementation
One of the largest healthcare providers in the country intended to implement a comprehensive referral authorization management program to update, modernize, and streamline their referral authorization system; implement a new module for their operating systems; rebuild a provider portal on a supportable and scalable technology platform; and update supporting benefits, providers, and claim data applications.
The two main drivers of the program involved meeting new regulatory requirements for electronic medical referrals and an organizational goal of automating the referral authorizations. The program was intended as an impetus for a significant organization transformation.
Brightwork Consulting was hired to provide leadership and project management services to develop business workflows, setup a digital ecosystem (including a member portal, provider portal, single sign-on, and affiliate links), and to drive issue resolution, remove roadblocks, and enable timely decision-making efforts. We performed a risk analysis concerning regulatory compliance to drive the overall project timeline and scope. We managed team-building efforts for the department constructing the new system and reported to the organizational steering committee on the project’s progress and risks.
We provided significant change management efforts, including coordinating the organization’s transformation through phases, schedules, and budget.
We provided significant change management efforts, including coordinating the organization’s transformation through phases, schedules, and budget. This included issues and problem management, risk mitigation, and deliverable coordination.
The program implemented new, proprietary applications and replaced legacy systems and portals. This positioned the organization to achieve regulatory compliance, reduce operational costs, and provide a streamlined care delivery process for members and staff. The organization’s goal was to meet 50-percent automation within three months of the launch, which we successfully met and has since been surpassed.
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