Education & Experience Required:

Current, unrestricted SW licensure to independently work within scope of practice within state of residence (BSW)
U.S. Citizenship
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background
investigation
Minimum of two of years' experience in case management, care coordination or discharge planning in an acute, ambulatory or specialty disease management program settings in a healthcare system or managed care organization (MCO)

Preferred:

Care or Disease Management experience with a managed care organization (MCO)
Master's degree in Social Work MSW;

LCSW, LMSW

Knowledge of government healthcare programs, TRICARE, and Medicare/Medicaid Key Responsibilities
Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiary's overall goals of care.
Collaborate with the clinical to contribute to the whole-person plan of care by incorporating behavioral and psychosocial assessment findings utilizing evidence-based guidelines, clinical reasoning and clinical practice guidelines.
Provide education and coaching support specific to the beneficiary's behavioral and psychosocial needs to prevent to support management of their chronic condition.
Manage activities necessary to ensure appropriate utilization and access to medical and behavioral resources, while maintaining optimal standards of care.
Review, identify and assist with identification and facilitation of resources related to health disparities identified through SDOH assessment.
Participates in the development of measurable outcomes, ensures measure are in place to monitor the impact of programs and services on the health status of beneficiaries being managed.
Assesses high risk factors, acuity and need for other TRICARE services and resources.
Facilitate transfer of beneficiary between the different regions and within the regions by collaborating with the military liaison to support the transition with minimal disruption.
Adhere to URAC standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.

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 Empathy /

Customer Service:

Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. 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. Multi-Tasking /

Time Management:

Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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. Team-Building /

Team Player:

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

Technical Skills:

Knowledge of TRICARE programs and benefits, managed care concepts, and URAC DM program standards; case management interventions, crisis intervention strategies, collaboration skills, legal and regulatory requirements, and HIPAA privacy regulations. Thorough knowledge of Case Management, Utilization Management, HIPAA Privacy and Security regulations.

Working Conditions 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 workspace and workstation 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. 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 $86, 000 to $95, 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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