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Job Summary
We offer remote work opportunities (AZ, *CO, IA, ID, MN, MO, MT, NV, NM, OR, SD, TX, UT, *WA, WI & WY only)
This role will be responsible for leading and implementing a complete Population Health program in support of the T-5 TRICARE West Region contract. This leader will collaborate with data management to utilize predictive and prescriptive analytics to stratify our beneficiary population for inclusion in multiple Medical Management programs; direct staff and interventions that will improve beneficiary health outcomes including HEDIS scores; develop and implement clinical programs to optimize Condition/Disease Management strategies and goals; and collaborate with leadership to enhance the overall healthcare education and knowledge of our beneficiaries using multiple platforms and experiences.
Education & Experience
Required:
- Bachelor's degree in Nursing, Health Care Administration, or Information Management
- Minimum of five years of management, with increasingly responsible experience in health care organization or managed care organization
- Minimum of five years of clinical experience
- Minimum of five years of disease management or population health operation and program development
- Experience in product development, project management, data management, data analysis, and team management
Preferred
- Master's Degree in Nursing, Health Care Administration or Business Administration
- Direct experience in population health programs
- Experience with HEDIS, data analysis and wellness program development
- Knowledge of government health care programs, TRICARE, and Medicare/Medicaid
Key Responsibilities
- Direct the overall operational leadership of Population Health (PH) functions and staff to ensure compliance with contract requirements and adherence to contract deliverables
- Develop and implement Condition/Disease Management (DM) programs that meet contract, HIPAA privacy and URAC requirements
- Develops and implements strategies to meet department objective to improve preventive care rates and demonstrate advances in population health markers
- Research high priority issues; including but not limited to predictive modeling, wellness and prevention programs, HEDIS, and programs to improve effectiveness of health care management programs
- Oversee development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards
- Directs the design of data collection tools, reports and administrative protocols for all PH programs performance management and contract reporting
- Work with executive leadership to ensure targets are met for the annual operating plan/financial management
- Performs annual and ongoing evaluation of the DM and PH programs to ensure adherence to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards
- Coordinate with Medical Director to educate and communicate expectations with providers
- Collaborates with network providers, Military Treatment Facilities and TRICARE Regional Office West (TROW) regarding Population Health program initiatives and responds to requests for assistance for program information or data
- Serves as designated Point of Contact to the TRICARE Regional Office West (TROW) on matters related to Population Health processes and contractual requirements
- 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.
Creativity / Innovation: Ability to develop unique and novel solutions to problems; view change as necessary.
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.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching.
Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
Technical Skills: Advanced knowledge of managed care principles; working knowledge of medical necessity review criteria, LOS, ICD, CPT, HCPCs and American Dental Coding required; quality management training/experience; extensive experience with relational databases and statistical analysis
Working Conditions
Working Conditions
- Availability to work non-regular hours as required
- Works within a standard office environment, with travel to other office locations
- 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
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.
