Market/MTF Opt Plan Mgr at TriWest Healthcare Alliance in Phoenix, Arizona

Job Description:

We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).

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

Supports Military Medical Treatment Facilities (MTFs) in optimizing opportunities for military medical personnel to achieve or maintain the clinical knowledge, skills, and abilities (KSAs) desired in a deployed environment. The incumbent reviews and analyzes MTF reported capacities and capabilities along with their prioritized CPT and ICD-10 codes that provide their medical personnel with the clinical experiences to achieve or maintain their readiness goals. The manager also analyzes network referral and claims data to identify business opportunities that optimize MTF capabilities and capacity, and collaborates with internal departments to strategically develop the network and identify community providers that can assist in supporting these readiness goals. The incumbent maintains a database for each geographic area that tracks MTF capabilities and capacities, and their priority CPT and ICD-10 codes, which they utilize to develop recommendations for internal and external stakeholders and decision makers.

Education & Experience

Required:

• Bachelor's degree in Business, Statistics, Economics or Health Care Administration or related field or equivalent work experience
• 5+ years of experience managing healthcare data analysis such as analysis of complex claims data and impact to network
• Working knowledge of ICD-10 and CPT codes

Preferred:

• Experience with the military health services system, health plans and network providers
• Experience with analysis of healthcare claims

Key Responsibilities

• Maintains a data base of the KSAs and their priority weighting by the MTFs within the assigned area of responsibility. Monitors the web-based system which Government Market/MTF Directors access to ensure that any updates made by them are captured for timely analysis, and informed recommendations. .
• Working within the TriWest medical management system and other applicable analytical applications, maintains a daily record of the referrals for TRICARE Prime beneficiaries enrolled to the network and highlights those referrals that would be useful for the MTF staff to achieve their highest value KSAs.
• Works in collaboration with committees and adhoc teams from the Data Management, Medical Management, and Provider Services departments, along with the Regional VPs and Directors to identify opportunities to improve the level to which MTFs achieve their military KSA/readiness goals.

• Supports the Regional VPs and Directors in developing information for their monthly meetings with the Market/MTF Directors and staff regarding the extent to which the contracted provider network is meeting their needs and to identify any upcoming changes that may require adjustments to the network. If changes are required, the incumbent will work with them to update their KSA data in the TriWest MTF Optimization Toolset's Capability and Capacity table.
• Attends meetings with MTFs in support of the Regional VPs and Directors (either in-person or virtually) as requested.
• Participates in and supports periodic special projects and work groups in the analysis of MTF KSA tables and development of potential business opportunities that may enhance the MTF staff capabilities and achievement of desired clinical skills.
• Provides direct support and assistance to the Regional VPs and Directors, and the Provider Services department in business plan development and updates.
• 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.

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.

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.

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, Managed Care, and Health Care Administration, Knowledge of relational databases and SQL server database administration; proficient with MS Excel Business systems analysis and project management.

Working Conditions

Working Conditions:

• Availability to work non-regular hours, including weekend events
• Works within a standard office environment, with moderate travel
• 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

*Annual base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $95,000 - $122,000 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.