Profile
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
This position oversees Case Management and related care coordination programs. Under the direction of the department Director, the Manager develops and implements policies and procedures for programs provided under Case Management. The Manager is accountable for department performance and facilitates collaboration with external entities such as network providers, customer staff and community-based programs.
Education & Experience
Required:
- Bachelor's degree in Nursing or related field or equivalent experience
- Current unrestricted RN license in the appropriate state or territory of the United States
- Must obtain a URAC-recognized Case Management certification within 2 years of hire
- 2 years case management and program management experience
- 2 years supervisory or management leadership experience in a healthcare environment
Preferred
- Master's degree in Nursing or related field
- Military or Veteran Health experience
- URAC-recognized Case Management Certification upon hire
- 2 years’ experience providing direct clinical care to patients
Key Responsibilities
- Supervises the program staff consistent with contracts, budgets and program regulations. o Selects, trains, coaches, and developments staff to ensure quality control and compliance with professional standards, Case Management Policies, Desk Procedures, contract requirements. . o Assesses effectiveness of training curriculum and supports Director with development initiatives. o Educates Case Management staff regarding URAC and/or other accreditation standards and changes to ensure compliance. Develops action plans to keep process in compliant with standards. o Develops documentation standards and templates for program-specific communications regarding program referrals, authorizations in collaboration with other TriWest departments. o Assists in the development of culturally competent tools and materials for Veteran education regarding clinical and psychosocial topics as well as Case Management. o Collaborates with VAMC and VACO staff, internal TriWest staff and other external referral sources on Case Management programs. o Manages outpatient care coordination for Veterans who do not opt in to case management, including program registration, enrollment, authorizations, and screening for special risk factors.
- Conducts case review program that includes audits to assure consistency and compliance with program registration, authorizations, and documentation processes, and implements program processes improvements. o Keeps the management team updated on significant issues. Assists in the preparation and presentation of cases for physician consultation and guidance involving high-profile or sensitive issues. o Provides oversight and direction for developing reporting tools for Case Management.. o Participates as a leader in the development, maintenance, and improvement of internal standards, desk procedures, and protocols. Ensures quality outcomes and compliance with other TriWest and customer specific policies and procedures. Supports TriWest initiatives for process improvement. o Collaborates with TriWest staff on Case Management issues, including Provider Services, Provider Education, Marketing, External Communications and Operations. Collaborates with Correspondence and Customer Relations to resolve customer complaints. Responds to VAMC or VACO service inquiries. o Participates in cross-functional teams for corporate projects. o 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.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.
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.
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.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Knowledge of programs and benefits, Managed Care, and healthcare principles and delivery systems, case management interventions, Psychosocial and community support systems, crisis intervention strategies, collaboration skills, legal and regulatory requirements, HIPAA privacy regulations, Medicaid and Medicare eligibility requirements and benefits, prospective payment methodologies, and health care reimbursement; Working knowledge of workers’ compensation principles; Proficient with the Microsoft Office suite of applications.
Working Conditions
Working Conditions
- Regular and reliable attendance is required o Availability to cover any work shift o Works within a standard office environment , with limited travel o Extensive computer work with long periods of sitting
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.
