Manager, CM Special Programs

Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MI, 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 Responsible for leading and managing a team of clinical and non-clinical staff in providing benefit administration, prior authorization and care coordination for TRICARE beneficiaries eligible for ECHO benefits and the Autism Care Demonstration Programs. Under direction from the Director of Case Management (CM), the Manager develops and implements program components to optimize CM and Care Coordination strategies and goals, and policies and procedures to ensure compliance with contract standards. Education & Experience Required Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), with current unrestricted license Bachelor's degree in a health-related field or equivalent experience If supporting TRICARE contract, must be a U.S. Citizen If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation 3 years full-time equivalent of direct clinical care 2 years case management or care coordination and program management experience 2 years supervisory or management leadership experience in a healthcare environment Preferred Medical Claims, Utilization or Case Management experience Clinical Experience related to children with disabilities, TRICARE ECHO and/or Autism Care programs Key Responsibilities Direct operational leadership of CM Special Program functions and staff to ensure compliance with contract requirements and adherence to contract deliverables. Monitors day-to-day operations of the CM Special Program team to identify barriers to providing excellent service to beneficiaries. Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals. Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care. Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the health status of beneficiaries being managed. Plans and implements orientation and training of new-hire employees. Ensure adherence to accreditation standards, contract policy, contractual requirements, and nationally recognized practice standards. Participates in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards. Participates in interdepartmental committees and/or workgroups that are pertinent to areas of responsibility. Performs other duties as assigned. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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. 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: Thorough knowledge of health care delivery, UM, CM, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Knowledge of TRICARE policies and procedures, Case Management, Utilization Management, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs, medical management systems, and protected health information; proficiency with the use of medical necessity criteria to evaluate care requests; working knowledge of medical coding. Working Conditions Availability to cover any work shift Remote work environment, with minimal travel required Extensive computer and telephone 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. 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 based on the specific role and location , but generally this position ranges from around $101,000 - $119,000 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. Applicants are considered for positions based on merit and 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. #J-18808-Ljbffr TriWest Healthcare Alliance