Education & Experience Required:

Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Independent Clinical Social Worker (LICSW), Licensed Clinical Social Worker (LCSW), Registered Nurse, or other licensed mental health professionals who possess a Certification in Case Management (CCM).
Three years full-time equivalent of direct clinical care to the consumer
Clinical experience in pediatrics, behavioral health, and/or ASD; a healthcare environment; and proven care management experience.
The ability to obtain an industry recognized certification in case management within four (4) years of hire.
Must be able to receive favorable Interim and adjudicated final Department of Defense (DOD) background investigation
U.

Citizenship Preferred:

2 years' experience working with those diagnosed with ASD and/or the

TRICARE ACD

2 years case management experience
Possess industry recognized case manager certification Key Responsibilities
Apply knowledge of HIPAA privacy and security regulations as well as accreditation standards to ensure compliance in daily practice.
Screen beneficiary needs and circumstances with predetermined program criteria to determine appropriateness for the ACD. Identify beneficiaries at high-risk for significant adverse health outcomes and with high-cost, clinical and psychological factors impacting care.
Educate beneficiaries on ACD and TRICARE benefits.
Provide timely decision of enrollment into the ACD and completes appropriate notifications.
Complete comprehensive case management assessments, and collaborates with the beneficiary, family and associated providers to develop an individualized comprehensive care plan (CCP) to assist beneficiaries with access to quality care in a cost-effective manner. Makes the CCP available to the beneficiary/family, Primary Care Manager (PCM) or other providers and updates the CCP as necessary.
Obtain necessary agreements for obtaining protected health information as needed.
Reassess and monitor CCPs for adjustments depending on needs, or on a monthly basis at a minimum, to address newly identified needs, services, treatment, and funding options. Documents changes and actions related to the CCP in the medical management system.
Evaluate case management outcomes, assessing the individual beneficiary's satisfaction and compliance with the care plan.
Prepare and present cases involving high-profile or sensitive issues to the Medical Director and/or the Defense Health Agency (DHA) for review and collaboration on issue resolution.
Function as an advocate for the beneficiary/family by ensuring access to necessary care and maintaining beneficiary safety, locating specialized services outside the network by identifying providers, exploring the nature of services offered, and facilitating collaboration with associated providers.
Support beneficiaries and families by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals.
Understands and participates in the administration of TRICARE benefits, including program registration, enrollment, authorizations, and screening for high risk factors indicating appropriateness for catastrophic case management services.
Provide direction and oversight to non-clinical, administrative staff tasked with administrative duties in support of the CCP, maintaining responsibility for these activities and their completion, and provide input into the performance of administrative staff.
Coordinate and participate in Medical Team Conferences with civilian and military and specialty care providers.
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies Communication /

People Skills:

Capacity to effectively influence and persuade individuals in diverse situations, adapt communication styles to varying contexts, actively listen, critically analyze information and foster collaboration

Computer Literacy:

Proficiency in navigating and utilizing various Microsoft application, including word and Outlook, as well as departmental specific software and internet-based tools within a multi-system environment. Coping /

Flexibility:

Capable of navigating through diverse situations and interacting effectively with individuals, while maintaining a sense of purpose and employing mature problem-solving skills, demonstrating adaptability and resilience Empathy /

Customer Service:

Customer centric approach that ensures patience, respect, attentive listening and empathy toward the perspective of the customer Independent Thinking /

Self-Initiative:

Resourceful critical thinker who can prioritize tasks essential to achieving desires outcomes, demonstration of a proactive commitment to task completion and the ability to identify and secure necessary resources. Multi-Tasking /

Time Management:

Proficient in prioritizing and managing task to meet evolving deadlines and requirements amidst a demanding and fast-paced environment characterized by high volume and stress.

Organizational Skills:

Skilled in coordinating people and tasks, adeptly adjusting to changing priorities, mastering systems efficiently within time constraints, and utilizing available resources with attention to detail. Problem Solving /

Analysis:

Proficient in problem-solving through systematic process analysis, guided by sound judgment an grounded in a practical grasp of pertinent issues. Team-Building /

Team Player:

Able to influence the actions and opinions of others in a positive direction and build group engagement.

Technical Skills:

Thorough knowledge of Case Management, Utilization Management, TRICARE policies and procedures, HIPAA Privacy and Security regulations, URAC accreditation standards, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs and medical management system. Proficiency if basic medical coding principles

Working Conditions Working Conditions:

Extensive computer/telephone work with long periods of sitting
Availability to cover any work shift 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 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 $83, 000 to $93, 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. 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