Manager, Care Management Special Programs Ops

Profile

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Must be a U.S. Citizen.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Responsible for providing operational management support for Special Programs supporting TRICARE beneficiaries eligible for Extended Care Health Options (ECHO) benefits and the Autism Care Demonstration (ACD) Programs. Under direction from the Director of Case Management (CM), Special Programs. this Manager develops and implements the operational program components to optimize CM and Care Coordination strategies and goals, and policies and procedures to ensure compliance with contract standards.

Education & Experience

Required:

• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• High School Diploma or G.E.D.
• Demonstrated proficiency and experience in all referral and authorization processes
• Proficient in Care Radius, DOMA and Patient Information Management System (PIMS) Experience with Microsoft Office
  
  

Preferred

• Experience researching referral and authorization issues in Care Radius, DOMA and PIMS
• Knowledge of medical terminology obtained through medical assistant certification or experience interpreting and applying ICD and CPT codes
• Managed Care experience
• TRICARE experience
• Veteran or military spouse or military affiliated
  
  

Key Responsibilities

• Performs extended provider searches when the referral specialist, contact center or MTF isn’t able to locate the requested provider/specialty needed. .
• Shares and collaborates with internal partners to resolve provider referral and authorization issues.
• Identifies potential discrepancies in the medical management system to assure quality compliance.
• Consistently meet department productivity and performance metrics.
• Follows HIPAA compliance and TriWest confidentially guidelines.
• Resolves issues to complete care request.
• Supports systems and process improvements and development of procedures and training documents.
• Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
• Assists with resolving data quality issues by identifying, documenting, and communicating quality issues.
• Resolve process issues to ensure high quality service levels throughout TriWest. ..
• Assesses electronic documents to ensure appropriate entry into the medical management system.
• Works with standard coding systems including standard medical taxonomy, ICD-10, CPT and HCPCS codes.
• Processes authorization requests and referral requests in the on-line medical management system as needed.
• Communicates with other departments, medical providers, and beneficiaries to clarify documentation prior to processing.
• Performs other duties as assigned.
• Regular and reliable attendance is required.
  
  

Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.

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.

Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

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.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Knowledge of TRICARE and the Military Health System programs; ability to use CHCS booking procedures, ATC standards and established clinic capability/booking protocols.

Working Conditions

• Ability to cover any work shift
• Ability to work overtime, if needed
• Onsite: Works within a standard office environment
• Remote: Private and secure workspace and workstation with high speed internet is required
• Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone
  
  

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Generous paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time
  
  

*Annual base salary for Colorado, Illinois, Minnesota, Hawaii, Washington D.C. and Washington State residents: $100,000 - $119,000 depending on experience*

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.