Job Summary

We offer remote work opportunities (AZ, AK, HI, *CO, IA, ID, MN, MO, MT, NV, NM, OR, SD, TX, UT, *WA, WI & WY only)

Provides Disease Management (DM) services to TRICARE beneficiaries. The DM nurse will collaboratively assess, plan, implement, coordinate, monitor and evaluate the beneficiary's health and psychosocial needs with a focus on empowering the beneficiary to successfully manage their chronic condition. The DM nurse will partner with the interdisciplinary care team to identify appropriate care to prevent complications related to chronic conditions and minimize the risk of potential exacerbation through the use of evidence-based condition-specific education and coaching. This role requires the individual to develop care plans in collaboration with providers, patients, families as appropriate and assesses the effectiveness and outcomes to improve individual health status.

Education & Experience

Required:

• Current, unrestricted RN licensure to independently work within scope of practice within state of residence
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• The ability to obtain multi-state licensure; if a resident in a NCL state
• Minimum of three years clinical experience
• Experience in case management, care coordination or discharge planning in an acute, ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO)

Preferred:

• Disease Management experience with a managed care organization (MCO)
• Bachelor's degree other related health field
• Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid

Key Responsibilities

• Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiaries overall goals of care.
• Ensure and evaluate clinical appropriateness of care plan by incorporating assessment findings against evidence-based guidelines, clinical reasoning and clinical practice guidelines.
• Provide education and coaching specific to the beneficiary needs to prevent to prevent exacerbations or worsening chronic conditions.
• Manage activities necessary to ensure appropriate utilization and access to resources while maintaining optimal standards of care.
• Review, identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
• Participates in the development of measureable outcomes, ensures measure are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
• Facilitate transfer of beneficiary between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.
• Adhere to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.
• Regular and reliable attendance.

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

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.

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 TRICARE programs and benefits, managed care concepts, and URAC DM program standards; case management interventions, crisis intervention strategies, collaboration skills, legal and regulatory requirements, and HIPAA privacy regulations. Thorough knowledge of Case Management, Utilization Management, HIPAA Privacy and Security regulations.

Working Conditions

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 work space and work station 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

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.