Job Summary

We offer remote work opportunities (AZ, CO, ID, MT, NV, NM, UT, WA & WY only)

Under the direction of the VP, Clinical Operations, this position is responsible for the development, implementation, evaluation, and direction of the Clinical Quality Management (CQM) program that supports the TRICARE West Region T-5 contract. Program activities include develop and implement quality and safety program processes, desk procedures and communications; oversee multiple quality studies; collaborate with VP of Clinical Operations to develop annual CQM program plan; oversee and monitor clinical quality outcomes dashboard and data reports; and collaborate with Chief Medical Officer and VP of Clinical Operations to oversee and monitor multiple quality committees in support of our Peer Review Organization (PRO). The position is accountable and responsible for managing CQM staff, meeting CQM contractual requirements, and ensuring compliance with URAC standards.

Education & Experience

Required:

• Registered Nurse with current unrestricted license
• Bachelor's degree in nursing or related field or closely related experience
• 5 years' clinical experience in Medical Surgical and Behavioral Health healthcare
• 3 years' experience in Quality Management
• 5 years' supervisory or management experience
• Knowledge HEDIS and Administrative measures

Preferred:

• Master's Degree in Nursing, Health Care Administration, or a related field
• Certified Professional in Healthcare Quality (CPHQ)

Key Responsibilities

• Supervision of all multi-functional PRO activities carried out by quality staff.
• Responsible for all activities associated with the TRICARE Quality Monitoring Contractor, Joint Quality Assurance Surveillance Plan (QASP), Joint Quality, and Safety Committees.
• Ensures contract compliance with government reporting requirements and Utilization Management (UM) focused studies operations.
• Ensures URAC readiness for core quality standards.
• Participates on all quality committees by submitting monthly, quarterly, and annual reports.
• Maintains the confidentiality and non-discoverability of all quality issues.
• Ensures appropriate documentation, implementation, and evaluation for corrective actions on defined quality issues are maintained.
• Supports Clinical Quality Management through education, policy development, and consultation.
• Responsible for hiring, training, and supervision of direct and indirect subordinates.

• Supports the annual review of the Clinical Quality Management Plan, Work Plan, Policies and Procedures, and Desk Procedures.
• Assists staff in identifying and conducting focused reviews.
• Assists staff in monitoring quality improvement activities.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

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.

Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.

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.

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.

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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: Proficient with Microsoft Word, Excel, PowerPoint, and Outlook; comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria.

Working Conditions

Working Conditions:

• Works within a standard office environment, with minimal travel
• Ability to lift 20 pounds
• Ability to use a computer and sit for prolonged periods
• 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.