Job Summary

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

Responsible for leading and directing a team of clinicians and health coaches that provide integrated Population Health (PH) and Disease Management (DM) program services and interventions for our beneficiaries under the direction of the Manager of Disease Management. The Supervisor is responsible for applying specific program and contractual guidelines to provide an integrated whole health service that improve healthcare outcomes and healthcare experiences to beneficiaries. Daily collaboration with the Manager of Disease Management and Director of Population Health is required to manage and develop clinical program components to optimize Population Health strategies and goals, and develop and implement policies and procedures to ensure compliance with URAC accreditation standards.

Education & Experience

Required:

• Bachelor's degree in Nursing or Social Work
• Current, unrestricted RN or LCSW license to independently work within scope of practice for the discipline within state of residence.
• The ability to obtain multi-state licensure; if required
• If supporting TRICARE contract, must be a U.S. Citizen
• If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Minimum of three years clinical experience with progressively responsible leadership experience in Population Health, Case or Disease Management operations and program development in a Managed Care Organization (MCO) or healthcare system

Preferred:

• Master's Degree in Nursing or Social Work
• Multi-State Licensure
• Direct experience in Managed Care, Population Health, Population Analytics or Wellness programs in a Managed Care Organization (MCO)
• Knowledge of government health care programs, TRICARE and/or Medicare/Medicaid
• Knowledge of ICD-10, CPT and HEDIS is a plus
• Experience in developing training, policies, procedures and desk procedures
• Proficient with computers and Microsoft Office suite of applications

Key Responsibilities

• Monitors day-to-day operations of the Disease Management and Population Health team to identify barriers to providing excellent service to TRICARE beneficiaries.
• Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
• Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care.
• Supports the implementation of orientation and training of new-hire employees.
• Ensure adherence to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.
• Participates in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
• Reviews referrals for Disease Management for appropriateness of program requirements.

• Participates in the management of beneficiaries' condition(s) by identifying problems, anticipating complications, addressing educational needs and SDoH resources and reinforcing treatment plans and orders.
• Assists in facilitation of beneficiary transfer between the different regions and within the region by collaborating with the military liaison to transition the beneficiary with minimal disruption of health care services.
• Performs other duties as assigned

.:
o Promotes health and education methods and encourages beneficiary and family involvement in patient care and treatment.
o Identifies potential clinical service, risk management and quality issues with referral to the appropriate review organization. .
o Participates on committees as directed by management.
o Performs other duties as assigned.
o 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 and demonstrate proficiency in Microsoft Office suite of applications, clinical program systems, and TriWest Intranet.

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.

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

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 manage large amounts of complex information, communicate clearly, and draw sound conclusions.

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 and health care administration concepts and principles; HIPAA; HEDIS and accreditation processes and the application of clinical criteria; working knowledge of managed care and chronic care program strategies and interventions; legal, regulatory requirements, and HIPAA privacy regulations; collaboration skills. Proficient with the Microsoft Office suite of applications.

Working Conditions

Working Conditions:

• Regular and reliable attendance
• Availability to work non-regular hours as needed
• Ability to travel as needed
• Extensive computer work with prolonged 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

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.