What are the responsibilities and job description for the Referral Management Program Manager position at TriWest Healthcare Alliance?
Job Details
We offer remote work opportunities in CA for this role.
Our Department of Defense contract requires ship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
The Referral Management Program Manager is responsible for advising on the design and planning of TriWest's TRICARE (T-5) referral and authorization processing operation. The Program Manager will help to facilitate direction in all aspects of building and optimizing the referral and authorization processing operation to include organizational design, workflow design, inventory management, staffing, systems development, stakeholder engagement, performance metrics, reporting and staff onboarding/training.
Education & Experience
Required:
Bachelor's degree in Business Administration Health Care Administration or similar degree; OR equivalent experience
5 years management level experience in TRICARE referral and authorization management
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
Proven ability to execute across internal and external stakeholder groups
Experience working on and influencing teams to produce desired outcomes
Experience with the Microsoft Product Suite
Preferred:
Experience with data analysis, statistical analysis, process flow mapping and report design, including proficiency with database querying
Key Responsibilities
Serves as a subject matter expert to support building out the referral and authorization processing operation. This will include program design, organizational design, staffing, workflow design, inventory management, system development review, reporting and staff onboarding.
Supports the development, implementation and updates to department policies, procedures and guidelines.
Assists with interviewing and selection of staff.
Collaborates to set performance metrics and how production and performance will be measured.
Assesses the impact of government contract requirements and specific business initiatives on operations and works towards operationalizing changes.
Identifies and communicates opportunities for redefinition of operational and management processes based upon application of best practices in order to improve operations effectiveness and efficiency.
Participates in systems development, performance and improvements.
Advises on interdependency engagements - internal and external partners. As needed, interacts with government points-of-contact on referral-related issues.
Helps develop referral and authorization training materials.
Assists with special projects and other duties, as assigned by TriWest Senior Leadership.
Competencies
Communication / People Skills: Clearly presents information through spoken or written communication; effectively reads others and adapts communication patterns to multiple individual styles; demonstrates ability to influence or persuade others in positive or negative circumstances; ability to listen critically for relevant information; clearly demonstrate respect for others.
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.
Independent Thinking / Self-Initiative: Critical thinker 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.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Detail-oriented; ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources.
Team-Building / Team Player: Ability to influence the actions and opinions of others in a positive direction and build group commitment; adapt to different styles; listen critically; collaborate.
Technical Skills: Advanced knowledge of Microsoft Word, Excel, and PowerPoint; ability to function without direction to produce outcomes within timelines; proficiency with project management skills, data analysis, and quality improvement concepts; collaboration skills and team-oriented approach; presentations and meeting facilitation skills.
Working Conditions
Working Conditions:
Availability to work non-regular hours, including weekends, as required
Works within a standard office environment, with up to 30% travel
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 ship 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:
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.
Our Department of Defense contract requires ship and a favorably adjudicated DOD background investigation for this position.
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
The Referral Management Program Manager is responsible for advising on the design and planning of TriWest's TRICARE (T-5) referral and authorization processing operation. The Program Manager will help to facilitate direction in all aspects of building and optimizing the referral and authorization processing operation to include organizational design, workflow design, inventory management, staffing, systems development, stakeholder engagement, performance metrics, reporting and staff onboarding/training.
Education & Experience
Required:
Bachelor's degree in Business Administration Health Care Administration or similar degree; OR equivalent experience
5 years management level experience in TRICARE referral and authorization management
Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
Proven ability to execute across internal and external stakeholder groups
Experience working on and influencing teams to produce desired outcomes
Experience with the Microsoft Product Suite
Preferred:
Experience with data analysis, statistical analysis, process flow mapping and report design, including proficiency with database querying
Key Responsibilities
Serves as a subject matter expert to support building out the referral and authorization processing operation. This will include program design, organizational design, staffing, workflow design, inventory management, system development review, reporting and staff onboarding.
Supports the development, implementation and updates to department policies, procedures and guidelines.
Assists with interviewing and selection of staff.
Collaborates to set performance metrics and how production and performance will be measured.
Assesses the impact of government contract requirements and specific business initiatives on operations and works towards operationalizing changes.
Identifies and communicates opportunities for redefinition of operational and management processes based upon application of best practices in order to improve operations effectiveness and efficiency.
Participates in systems development, performance and improvements.
Advises on interdependency engagements - internal and external partners. As needed, interacts with government points-of-contact on referral-related issues.
Helps develop referral and authorization training materials.
Assists with special projects and other duties, as assigned by TriWest Senior Leadership.
Competencies
Communication / People Skills: Clearly presents information through spoken or written communication; effectively reads others and adapts communication patterns to multiple individual styles; demonstrates ability to influence or persuade others in positive or negative circumstances; ability to listen critically for relevant information; clearly demonstrate respect for others.
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.
Independent Thinking / Self-Initiative: Critical thinker 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.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Detail-oriented; ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources.
Team-Building / Team Player: Ability to influence the actions and opinions of others in a positive direction and build group commitment; adapt to different styles; listen critically; collaborate.
Technical Skills: Advanced knowledge of Microsoft Word, Excel, and PowerPoint; ability to function without direction to produce outcomes within timelines; proficiency with project management skills, data analysis, and quality improvement concepts; collaboration skills and team-oriented approach; presentations and meeting facilitation skills.
Working Conditions
Working Conditions:
Availability to work non-regular hours, including weekends, as required
Works within a standard office environment, with up to 30% travel
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 ship 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.
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
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