Manager, Referral Management

TriWest Healthcare Alliance Corp.; Phoenix (AZ); Remote; USD 51,000 - 57,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) with match

Disability & life insurance

Tuition reimbursement

Volunteer time

Job summary

TriWest Healthcare Alliance Corp. seeks a Manager to lead the Referral Management team supporting TRICARE beneficiaries. Under the Director of Referral Management, you will guide non-clinical staff to ensure accuracy, efficiency, and timely processing of network and military referrals.

You will develop referral program components to optimize automation and improve beneficiary, provider, and military satisfaction. Remote work options are available; DoD background clearance is required.

Qualifications

• Graduate of Military Medical Training or 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.
• Bachelor's Degree in Health Administration or related medical field preferred.
• Three years' experience in a clinical environment (Medicare/Medicaid/inpatient or outpatient care).
• Knowledge of TRICARE program and Military Health System (MHS).

Responsibilities

• Direct operational leadership of RM functions and staff to ensure contract compliance and contract deliverables.
• Plans, organizes, and implements data collection and reports to support RM management activities and contract standards.
• Evaluate staff performance and coach; complete annual performance appraisals.
• Supervise staff: interviewing, hiring, orientation, training, and performance management.
• Develop and maintain expertise in contract and accreditation requirements for referral management.
• Serve as primary clinical resource for TRIAD data and readiness initiatives.
• Provide clinical support and interpretation to non-clinical staff for medical/surgical and behavioral health conditions.
• Participate in desk procedures development, education, and auditing for program policy adherence.
• Participate in cross-functional teams to enhance strategies and process improvement.
• Perform other duties as assigned; maintain regular attendance.

Skills

Communication

Computer literacy

Leadership

Multi-tasking

Problem solving

Time management

Independent thinking

Information management

Coping / flexibility

High intensity environment

Education

Military Medical Training

Accredited Medical Assistant certification

Equivalent medical operational experience

Bachelor's Degree in Health Administration

Job description

Profile

We offer remote work opportunities (AK, AR, AZ, 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

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 environmentExperience 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

• 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

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.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

Benefits

• Medical, Dental and Vision Coverage
• 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

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $51,000 - $57,000 per year.

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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.