Remote Referral Management Lead (DoD/TRICARE)

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

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.