Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!
We offer remote work opportunities (AR, AZ, *CO, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, ND, OK, OR, SD, TX, UT, *WA, WI & WY only)
Job Summary
Responsible for leading and directing a team of clinical specialists under the direction of the Director, Case Management for T5 Clinical Operations. The Manager will lead and guide staff in providing integrated services to and for our beneficiaries. Responsible for applying specific guidelines and procedures to apply advanced technical knowledge to solve moderately complex problems. Collaboration with the Director, Case Management to develop care coordination program components to optimize care coordination strategies and goals, and develop and implement policies and procedures.
Education & Experience
Required:
- Bachelor’s degree in Nursing, Healthcare Administration, or related field
- Active, unrestricted license in state of residence if RN/LCSW
- Minimum of five years managed care experience with progressively responsible management experience in CM or DM operations and program development
Preferred:
- Direct experience in Case Management programs
- Demonstrated experience in utilization management
- Knowledge of government health care programs, TRICARE, and Medicare/Medicaid
Key Responsibilities
- Direct operational leadership of Care Coordination functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
- Monitors day-to-day operations of the Care Coordination team to identify barriers to providing excellent service to TRICARE beneficiaries.
- Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
- Manages activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care.
- Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
- Plans and implements orientation and training of new-hire employees.
- Ensure adherence to TRICARE policy, contractual requirements, and nationally recognized practice standards.
Participates in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.- Participates in interdepartmental committees and/or workgroups that are pertinent to areas of responsibility.
- Participates in cross-functional teams for corporate projects.
- Performs other duties as assigned.
Competencies
Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Easy to do business with across interdepartmental teams, vendors, and clients.
Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Ability to influence or persuade others under positive or negative circumstances.
Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. Innovative in problem solving approach and embracing change management.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Ability to function in fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Successfully manage different styles of employees through effective coaching.
Technical Skills: Knowledge of TRICARE programs or VA Healthcare and benefits, Managed Care, and healthcare principles and delivery systems, URAC national best-practice standards; case management interventions, , crisis intervention strategies, collaboration skills, legal and regulatory requirements, HIPAA privacy regulations, and proficient with Excel, and PowerPoint.
Working Conditions
Working Conditions:
- Remote/virtual environment
- Regular and reliable attendance is required
- Availability to cover any work shift
- Ability to travel as needed
- Extensive computer work with long periods of sitting
- Department of Defense security clearance required