Manager, Case Management (Finance)

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

Responsible for leading all Case Management and Care Coordination programs and staff that provide integrated, whole health services in conjunction with corporate goals and objectives under the direction of the Director of Case Management. The Manager develops and implements clinical program components to optimize CM strategies, goals, policies and procedures to ensure compliance with contract and accreditation standards.

Education & Experience

Required:

• Bachelor's degree in Nursing or related field or equivalent experience
• Current unrestricted RN license in the appropriate state or territory of the United States
• Must obtain a URAC-recognized Case Management certification within 2 years of hire
• 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
• Minimum of five years clinical experience with progressively responsible management experience in CM or DM operations and program development

Preferred:

• Master's degree in Nursing or related field
• Military or Veteran Health experience
• URAC-recognized Case Management Certification upon hire
• 2 years' experience providing direct clinical care to patients

Key Responsibilities

• Direct operational leadership of Case Management functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
• Monitors day-to-day operations of the Case Management 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 measureable 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 strategies for 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.
• Participates in cross-functional teams for corporate projects.
• Performs other duties as assigned.

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.

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; case management interventions; psychosocial and community support systems and crisis intervention strategies; collaboration skills; legal, regulatory requirements and HIPAA privacy regulations. Working knowledge of workers' compensation principles; Proficient with the Microsoft Office suite of applications.

Working Conditions

Working Conditions:

• Remote/virtual environment
• Regular and reliable attendance is required.
• Availability to cover any work shift
• Ability to travel as needed
• 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

*Annual base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $110,000 - $140,000 depending on experience*

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.