Profile
*Must reside in Hawaii to be eligible for this position*
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Coordinates transitions of care for TRICARE beneficiaries. Care Coordinators receive inbound calls and make outbound calls to support care coordination needs across the TRICARE West Region. Care Coordinators report to the Supervisor, Care Coordination.
Education & Experience
Required:
- Licensed Practical or Vocational Nurse (LPN/LVN), with current unrestricted license in appropriate state or territory of the United States
- U.S. Citizenship
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
- 2+ years’ clinical nursing experience
- Proficiency in medical data entry, written skills and Microsoft Office
- Exceptional oral communication skills, strong organizational skills and easily adapts to change
Preferred
- 3 years’ clinical experience
- 2+ years’ Managed Care experience
Key Responsibilities
- Utilizes clinical and analytical skills to identify care coordination needs and facilitate care during any type of transition of care.
- Communicates with community providers, TRICARE beneficiaries, Military Treatment Facilities (MTF), Veterans, VAMCs and facilities to coordinate care.
- Ensures authorizations are in place to meet clinical care needs.
- Accurately and completely document coordination activities in the Medical Management System (MMS).
- Refer cases to other TRICARE programs as indicated.
- Participates in Quality Improvement Projects as indicated in project documents.
- Identifies and reports potential quality or fraudulent cases to Clinical Quality and/or Program Integrity,
- Perform other duties as assigned.
- Regular and reliable attendance is required.
Competencies
Commitment to Task: Ability to conform to established policies and procedures; exhibit high personal motivation.
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 Teams, 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 a mature problem-solving approach is required. Ability to accept change and maintain a positive team atmosphere.
Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, with empathy and compassion for another's position.
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: Thorough knowledge of internal policies and procedures, utilization management principles, managed care concepts, medical terminology, and medical management system, clinical decision support tools, International Classification of Diseases, and Current Procedural Terminology. Ability to meet or exceed production standards in compliance with contract.
Working Conditions
Working Conditions
- Availability to work any shift
- Works within a standard office environment, or work from home
- Extensive phone and computer work with prolonged 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.
DoD Statement
Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.
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 Hawaii residents: $62,000 - $80,000 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.
