Manager, Care Coordination at TriWest Healthcare Alliance in Phoenix, Arizona

Job Description:

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

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 and Washington State residents: $104,000 - $116,000 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.

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