What are the responsibilities and job description for the Clinical Nurse, Case Management position at CICONIX, LLC?
Clinical Nurse, Case Management
Upcoming program - help shape healthcare for the military!
The program supports the Healthcare Operations (HCO) Directorate, including TRICARE Health Plan (THP), Clinical Services, and related staff. It covers services for the management of THP programs, the Military Health System (MHS) health plan, TRICARE purchased health care services, human resources programs, and the operations of the HCO, THP Overseas Program, and the THP Front Office. The goal is to ensure the successful execution of the THP enterprise's missions and functions.
Responsibilities:
Provides expertise for all aspects of Case Management (CM)/Special Needs (SN) performance for care delivered under the MCSCs and six Designated Providers. At a minimum provide the following subtasks:
- Assess compliance related to specific standards, metrics, and outcomes. Provide efforts to improve patient outcomes and the efficiency and effectiveness of regional CM/SN programs.
- Provide oversight of complex care coordination involving cross-regional moves, special needs beneficiaries. Advocates for beneficiary special needs to secure access to healthcare under the TRICARE program.
- Review and evaluate conflicts and programmatic issues in an effort to resolve issues and to improve patient access, efficiency, and effectiveness of regional care.
- Provide advisory consultative services regarding the case management program activities.
- Serve as the primary point of contact and liaison regarding integration of CM programs that would enhance the services and quality of care to TRICARE beneficiaries.
- Conduct research, review, and analysis on unforeseen, highly complex issues related to health benefits, cost containment, and the organization of program resources.
- Participate in and advise DHA and clinical committees in the development of recommendations for regulations, guidelines, and procedures relating to program and business operations in addition to clinical operations for issues such as optimization or innovative improvement programs.
Requirements:
- Bachelor's degree in Nursing. Masters preferred, or other clinically related Health Service degree.
- Department of Defense Program Management (PM) experience preferred, minimum 2 years within the last 5 years.
- Experience in the operations and organization of the Department of Defense Military Health System desired
Positions are contingent and will begin upon contract award.
About CICONIX: CICONIX LLC is a Veteran Owned Small Business specializing in business advisory and technical assistance for military health programs. We value exceptional people, unwavering integrity, inclusive collaboration, and enduring impact.
The Defense Health Agency (DHA) Healthcare Operations oversees the delivery of healthcare services to military personnel, their families, and eligible beneficiaries within the U.S. Department of Defense. This division focuses on improving operational efficiency, streamlining processes, and ensuring high-quality care across military treatment facilities, while supporting readiness and compliance with military health regulations.
CICONIX, LLC is an Equal Opportunity Employer, including disability/vets. We E-Verify all employees.
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