Education & Experience Required:

Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), with a current unrestricted license
Case Manager Certification by a URAC-recognized entity
If supporting TRICARE contract, must be a U.S. Citizen
If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
3 years full-time equivalent of direct clinical care to the consumer
2 Years Case Management or equivalent experience
One year supervisory experience or equivalent leadership role

Preferred:

Bachelor's degree or higher in health-related field
Experience in Managed Care or TRICARE healthcare delivery system Key Responsibilities
Supervises the daily operations of case management services. Hires, trains, coaches, counsels, and develops clinical and non-clinical staff. Supports recruitment efforts by interviewing, selecting, and training new staff.
Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.
Coordinates staff orientation and training. Ensures staff provides case management within scope of practice and in compliance with organizational protocols, desk procedures, and policies. Provides staff training, including training aids. Documents and assesses effectiveness of staff training.
Supervises individual staff caseload and beneficiary treatment plans to ensure delivery of care, productivity, and timeliness. Evaluates case manager practice for quality, timeliness, and process consistency. Conducts regular and ad hoc case review audits, providing staff feedback regarding results and process improvement. Participates in the evaluation of the case management program.
Ensures compliance with TriWest policy and Health Care Services desk procedures.
Collaborates with case managers, care coordinators, medical providers, the Director, Case Management and the Medical Director for Case Management on program interpretation and guidance.
Participates in clinical and non-clinical performance improvement projects. Actively participates in teleconferences and meetings.
Monitors and provides input on the performance of non-clinical staff.
Supports department by carrying a case load as necessary.
Performs other duties as assigned.
Regular and reliable attendance is required.

Competencies Coaching / Training /

Mentoring:

Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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.

Delegation Skills:

Provide clear performance expectations for projects and ensure adequate access to resources for completion.

Organizational Skills:

Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Problem Solving /

Analysis:

Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues, tactics, and strategies. Team-Building /

Team Player:

Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills:

Thorough knowledge of TRICARE policies and procedures, Case Management, Utilization Management, HIPAA Privacy and Security regulations, URAC accreditation standards, Managed Care concepts, Behavioral Health practices and principles, community resources, alternative funding programs, medical management systems. Proficiency with International Classification of Diseases, Current Procedural Terminology, Healthcare Common Procedural Coding System.

Working Conditions Working Conditions:

Availability to cover any work shift
Works within a standard office environment, with minimal travel
Extensive computer work with prolonged sitting 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\nTriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $88, 000 - $103, 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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