What are the responsibilities and job description for the Director, Case Management Special Programs position at TriWest Healthcare Alliance?
Profile
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
Responsible for system-wide development, implementation, evaluation and management of the staff associated with the Case Management Special Programs that support the T-5 TRICARE West Region Contract. Under the direction of the Vice President of T-5 Clinical Operations, this position will have the responsibility to develop clinical program components to optimize Extended Care Health Options (ECHO), Autism Care Demonstration (ACD), Individual Case Management For Person With Extraordinary Conditions (ICMP), Custodial Care Transition Policy (CCTP) program strategies and goals, and develop and implement policies and procedures to ensure compliance with URAC accreditation standards and develops training aides to support policies. This position also oversees ECHO and ACD quality improvement projects and auditing for performance management and improvement.
Education & Experience
- Current, unrestricted Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) license recognized as valid by the applicable state licensure board where the position is located
- Bachelor's Degree in Nursing, Social Work, Health Care Administration or other health related field
- URAC recognized Case Manager Certification
- U.S. Citizenship
- Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
- Minimum of five (5) years clinical experience
- Minimum of five (5) years progressively responsible management experience
- Minimum of five (5) years’ experience in Case Management and program development
- Previous experience as a director of case management
- Government or commercial managed care experience
- Experience in programs supporting children with disabilities, TRICARE ECHO and/or Autism Care
- Masters of Healthcare Administration or similar
- Demonstrated experience in performing analysis of utilization and quality data
- Knowledge of government health care programs, TRICARE or Medicare/Medicaid
- Veteran, military spouse or military affiliated
Key Responsibilities
- Direct the overall operational leadership of Case Management Special Program functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
- Performs clinical program analyses to establish program impact, identify opportunities for improvement and recommend strategies to achieve goals and performance targets.
- Work with executive leadership to ensure targets are met for the annual operating plan/financial management.
- Performs annual and ongoing evaluation of the programs to ensure adherence to URAC standards, TRICARE policy, contractual requirements, HIPAA privacy and nationally recognized practice standards.
- Serves as designated Point of Contact to the TRICARE Clinical Oversight and Integration office on matters related to ECHO and Autism processes and contractual requirements.
- Develops desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
- Directs and administers TRICARE Specialty Programs, demonstrations, and benefits to beneficiaries.
- Directs the design of data collection tools, reports and administrative protocols for CM program performance management and contract reporting.
- Coordinate with Medical Director to educate and communicate expectations with providers.
- Collaborates with network providers, Military Treatment Facilities and TRICARE Clinical Oversight and Integration staff regarding program initiatives and responds to requests for assistance for program information or data.
- 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.
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.
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.
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. Ability to plan, implement, and monitor program effectiveness and efficiency.
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, and healthcare principles and delivery systems; knowledge of CMSA, URAC national best-practice standards, case management interventions, Psychosocial and Support Systems, crisis intervention strategies, collaboration skills, legal and regulatory requirements, HIPAA privacy regulations, Medicaid and Medicare eligibility requirements and benefits, prospective payment methodologies, and Health Care Reimbursement; working knowledge of worker compensation principles; proficient with ACCESS, Excel, and PowerPoint.
Working Conditions
- Availability to work non-regular hours as required
- Works within a standard office environment both virtually and with travel to other office locations
- Extensive computer work with long periods of 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
- Generous 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
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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions 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.
Salary : $151,000 - $194,000
