What are the responsibilities and job description for the VP, Clinical Operations position at TriWest Healthcare Alliance?
Profile
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).
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
Maintains direct operational oversight and management of the Medical Management (MM), Utilization Management (UM), Case Management (CM), Disease Management (DM), Clinical Quality Management (CQM), and Population Health (PH) programs. Responsible for TriWest Clinical Operations policies, procedures, and Government deliverables (CDRLs) addressing all medical management activities. Translates the Defense Health Agency (DHA) directives, TriWest mission and vision statements, and Clinical Operations policies and procedures into operational activities within Clinical Operations. In collaboration with the Chief Medical Officer and other cross-functional leads across the organization, defines policy, sets objectives and ensures compliance with contract requirements, plans and objectives of TriWest (TW). Coordinates with SVP Medical Management on corporate strategic planning. Works to integrate support to TRICARE and Veteran Affairs Clinical Operations where applicable.
Education & Experience
Required:
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Creativity / Innovation: Ability to develop unique and novel solutions to problems; view change as necessary.
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.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Expertise with project management, strategic planning, and program development; expertise with performance metrics and analysis for driving management decision-making; collaboration and group facilitation skills.
Working Conditions
Working Conditions
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:
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.
We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only).
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
Maintains direct operational oversight and management of the Medical Management (MM), Utilization Management (UM), Case Management (CM), Disease Management (DM), Clinical Quality Management (CQM), and Population Health (PH) programs. Responsible for TriWest Clinical Operations policies, procedures, and Government deliverables (CDRLs) addressing all medical management activities. Translates the Defense Health Agency (DHA) directives, TriWest mission and vision statements, and Clinical Operations policies and procedures into operational activities within Clinical Operations. In collaboration with the Chief Medical Officer and other cross-functional leads across the organization, defines policy, sets objectives and ensures compliance with contract requirements, plans and objectives of TriWest (TW). Coordinates with SVP Medical Management on corporate strategic planning. Works to integrate support to TRICARE and Veteran Affairs Clinical Operations where applicable.
Education & Experience
Required:
- Bachelor's in Nursing or related field or Master's in Health Care Administration or related field
- 10 years of executive-level management and leadership experience in the healthcare field
- For registered nurses (RNs), an unrestricted license with 10 years clinical practice experience
- Eligible to hold Department of Defense and VA security clearances
- Extensive knowledge of private sector and/or government health care programs, especially TRICARE program
- Demonstrates strategic competence by supporting company strategic planning, communicating strategic plans, and implementing plans within Clinical Operations.
- Provides all required MM, UM, CM, DM, PH, and CQM program reports for communication to the Operations Committee, Executive Operations, Core Leadership Team (CLT), TriWest Board of Directors, Regional Director, MTF Commanders and Contracting Officer.
- Ensures, with SVP Medical Management, Clinical Operations meets or exceeds contract requirements, Clinical Operations performance standards, and TriWest goals. Processes will be continuously evaluated and corrective actions for improvement will be implemented.
- Directly responsible to SVP MM for all operations and management activities of the MM, UM, CM, PH, and CQM departments.
- Updates and monitors all applicable TRICARE CDRLs related to MM, UM, CM, PH, and CQM.
- Responsible for developing and maintaining all policies and procedures related to MM, UM, CM, PH, and CQM.
- Serves as primary or alternate point of contact for Quality Management Contractor (TQMC) (or other approved quality group) regarding program-related questions or concerns.
- Serves, in coordination with the Medical Directors, as liaison between TriWest and the community of physicians and other providers for explaining TriWest policies and procedures.
- Attends, in coordination with SVP MM, TriWest Committee meetings related to MM, UM, CM, PH, and CQM.
- Evaluates, monitors and addresses utilization/quality management, issues of non-compliance with required standards of performance, access, population health (HEDIS), clinical performance indicators and cost of care.
- Addresses network health care services issues related to utilization review/quality activities with respective subcontractor representatives as required.
- Ensures the implementation of annual performance plans, annual evaluations, employee surveys and corrective action plans for Clinical Operations staff.
- Ensures compliance with timeliness standards for review completion in coordination with and in support of the Directors of UM, CM, CQM, and PH.
- Monitors and reviews decision-making process and provides critical feedback to staff as indicated, in coordination with and support of the Directors of MM, UM, CM, PH, and CQM.
- Works closely with TriWest Data Management Team to support various analytic needs related to medical management (e.g. predictive analytics, AHRQ required data analytics, various required MM dashboards, etc.).
- Assists health care analysts (both internal and external) with the development of appropriate health care studies, including the development of Quality and Value Improvement Initiatives (QVIIs).
- Responsible for strategic oversight of all vendor/partner relationships related to MM (e.g. UM partners, PH partners, etc.).
- Responsible for the utilization and quality management activities of the multi-functional PRO.
- Performs other duties as assigned.
- Regular and reliable attendance is required.
Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
Creativity / Innovation: Ability to develop unique and novel solutions to problems; view change as necessary.
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.
Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Expertise with project management, strategic planning, and program development; expertise with performance metrics and analysis for driving management decision-making; collaboration and group facilitation skills.
Working Conditions
Working Conditions
- Availability to work non-regular hours
- Works within a standard office environment and remote, with moderate travel
- Extensive computer work with prolonged sitting
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
- 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
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.
