Supervisor, Referral Management

TriWest Healthcare Alliance Corp.; Phoenix (AZ); Remote; USD 68,000 - 72,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Paid time off

401(k) Retirement Savings Plan (with 1

Short-term and long-term disability,基本

Job summary

TriWest Healthcare Alliance Corp. is seeking a Referral Management Supervisor to direct RM services operations and oversee non-clinical data entry in the CareRadius system. You will ensure contract compliance and provide leadership to RM staff in a high-volume environment.

Requirements include U.S. citizenship and the ability to obtain a favorable DoD background investigation, plus 2+ years in an administrative or supervisory role within healthcare operations.

Qualifications

• High School Diploma or G.E.D.
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final DoD background investigation
• 2+ years’ experience in an administrative setting such as health care operations
• Two or more years of supervisory experience in managed care/medical management systems

Responsibilities

• Directs daily referrals management operations and supervises RM staff
• Ensures quality staff training and oversees orientation of new hires
• Plans and implements staff development activities
• Ensures RM procedures comply with contract requirements
• Assesses staff performance and conducts annual evaluations
• Functions as SME for information management in online medical management system
• Supports RM by serving in RM Specialist role when needed
• Resolves complex provider and beneficiary issues
• Represents RM on Utilization Management subcommittee as needed
• Collaborates with departments, providers and beneficiaries to ensure accurate documentation
• Participates in TriWest meetings and initiatives
• Prepares management reports and tracks department outcomes
• Keeps staff informed of procedural changes via meetings and updates

Skills

Communication

Leadership

Multi-Tasking

Problem Solving

Information Management

Technical Skills

Coping / Flexibility

Education

High School Diploma or GED

Tools

CareRadius

Microsoft Word

Microsoft Outlook

TriWest Intranet

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

Directs the Referral Management (RM) Services operations and staff in processing and production standards of documents and/or electronic files regarding health care authorizations and referral requests from network and military treatment facility providers. Functions as Subject Matter Expert for non-clinical aspects of data entry into TriWest medical management system (CareRadius). Ensures contract compliance for the non-clinical aspects of data entry for the TRICARE T-5 West Region Contract. Serves as a role model for the Referral Management Specialists in the areas of communication and customer service. Provides oversite for staff training and quality assurance as well participation in process improvement activities.

Education & Experience

Required:

• High School Diploma or G.E.D.
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 2 + years’ experience in an administrative setting such as health care operations
• Two or more years of supervisory experience Managed care and operational experience in medical management systems, including referral management/prior authorization, or utilization management.

Preferred

• Two years or more experience in customer service, medical office or hospital.
• Prior experience with remote work environments
• Experience with TRICARE, VA, or military experience

Key Responsibilities

• Directs the daily operations and supervises Referral Management staff in the processing of health care authorizations and referral requests. Supports recruitment efforts by interviewing, selecting, and training new staff
• Ensures the quality of Referral Management staff training. Plans and implements orientation and training of newly-hired employees.
• Plans, organizes and implements staff training and staff development activities. Ensures department meets all training requirements.
• Ensures Referral Management desk procedures comply with contract requirements.
• Assesses staff performance, advises and counsels, and conducts annual performance evaluations.
• Functions as Subject Matter Expert regarding information management in on-line medical management system.
• Supports Referral Management by functioning in RM Specialist role when needed.
• Resolves complex provider and beneficiary issues
• Ensures staff compliance with TRICARE T-5 contractual requirements, including turnaround time.
• Represents Referral Management on Utilization Management subcommittee as necessary.
• Collaborates with other departments, medical providers, and beneficiaries to ensure accurate documentation.
• Participates in TriWest meetings and initiatives as requested.
• Supports processes to track department outcomes and prepares management reports.
• Ensures staff is fully-informed of procedural changes and significant events impacting workflow by coordinating staff meetings and sending email updates.
• Participates in focused studies and performance improvement activities as required.
• 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; has a realistic understanding of relevant issues

Technical Skills: Thorough knowledge of TRICARE policies and procedures, data collection and reporting, TriWest Care Radius medical management systems, and Referral Management Specialists function

Working Conditions

• Ability to cover any work shift
• Ability to work overtime, if needed
• Onsite: Works within a standard office environment
• Remote: Private and secure work space and work station with high speed internet is required
• Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

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

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
• 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 $68,000 - $72,000 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.