Manager, Referral Management

TriWest Healthcare Alliance; Phoenix (AZ); Remote; USD 50,000 - 70,000; Full time

Job summary

TriWest Healthcare Alliance is seeking a Manager to lead referral management processes for TRICARE beneficiaries in Phoenix. This role involves supervising non-clinical staff, ensuring compliance with contractual obligations, and optimizing program components to enhance beneficiary satisfaction. Qualified candidates should have supervisory experience and relevant medical training.

Qualifications

• Two years or more of supervisory or managerial experience in a clinical environment
• Knowledge of TRICARE program and health care delivery processes

Responsibilities

• Lead and guide non-clinical staff in referral management processes
• Direct operational leadership of RM functions and staff

Skills

Leadership

Communication

Problem Solving

Time Management

Education

Graduate of Military Medical Training or equivalent medical operational experience

Bachelor's Degree in Health Administration or related medical field

Tools

Medical management systems

Microsoft Office Suite

Job description

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Job Summary

Responsible for leading a team that provides support for all referral management processes to meet contractual requirements and corporate goals for TRICARE beneficiaries. Under the direction of the Director of Referral Management, the Manager will lead and guide non-clinical staff in processes that maintain accuracy, efficiency, and timeliness for all network and military referral requests. Manager also works to develop and implement referral program components to optimize automation and facilitates excellent beneficiary, provider, and military satisfaction.

Profile

Job Summary

Responsible for leading a team that provides support for all referral management processes to meet contractual requirements and corporate goals for TRICARE beneficiaries. Under the direction of the Director of Referral Management, the Manager will lead and guide non-clinical staff in processes that maintain accuracy, efficiency, and timeliness for all network and military referral requests. Manager also works to develop and implement referral program components to optimize automation and facilitates excellent beneficiary, provider, and military satisfaction.

Education & Experience

Required:

• Graduate of Military Medical Training (e.g. medic, corpsman), accredited Medical Assistant certification or equivalent medical operational experience
• Two years or more of supervisory or managerial experience in a clinical environment or medical office
• Managed care and operational experience with medical management systems including referral management, prior authorization or utilization management
  
  

Preferred

• Bachelor's Degree in Health Administration or related medical field
• Three years' experience in a clinical environment (Medicare, Medicaid, inpatient or outpatient care)
• Two years or more experience in a production environment
• Experience with TRICARE Program
• Knowledge of Military Health System (MHS)
  
  

Key Responsibilities

• Direct operational leadership of RM functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
• Plans, organizes, and implements collection of data and preparation of reports that support RM management activities and compliance with contract standards.
• 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.
• Supervise staff to include interviewing and hiring; planning and implementing orientation and training strategies for new-hire employees; setting and managing expectations, coaching and ensuring team and individual goals are met.
• Develops and maintains expertise in contract and accreditation requirements as they pertain to referral management functions.
• Serves as primary clinical resource for the T-5 Readiness Integration and Delivery Team (TRIAD).
• Provides clinical support and interpretation assistance to non-clinical staff for both medical/surgical and behavioral health conditions.
• Participates in development and annual review of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
• Participates in cross-functional teams to enhance business strategies, process improvement and use of industry best practices.
• 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.

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; have a realistic understanding of relevant issues.

Technical Skills: Knowledge of TRICARE program and benefits; managed care program concepts and health care delivery processes; management reporting tools and medical management systems; legal, regulatory requirements, and HIPAA privacy regulations. Proficient with the Microsoft Office suite of applications.

Working Conditions

Working Conditions

• Remote/virtual environment if preferred
• Availability to cover any work shift
• Ability to travel as needed
• Extensive computer work with long periods of sitting
• Department of Defense security clearance required

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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