Job: Manager, Clinical Liaison RN

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Jobing Description

Job Summary

Primary responsibilities are performed in a TRICARE Service Center (TSC) located in a Military Treatment Facility (MTF), most often on a military installation. Manages the activities of the TSC to ensure compliance with contractual requirements and maintenance of customer service standards. Serves as the primary liaison between the MTF, Hub Health Care Services and Contact Center staff regarding TSC operations, network adequacy/availability, and referral/authorization issues. Clinical advisor to the Service Area Director (SAD), assisting in building and maintaining relationships between the Hub, MTF staff, and civilian providers and facilities; supports MTF Optimization initiatives.
Key Responsibilities

o Supervises TSC staff.
o Conducts ongoing TSC staff development activities, including routine performance feedback and counseling.
o Acts as a clinical resource for the Service Area Director (SAD), Healthcare Coordinator (HCC) and/or non-clinical TSC staff regarding beneficiary care issues.
o Provides operational and clinical support to other TSCs within the Operations Area, as warranted
o Ensures implementation and compliance with TriWest policies, procedures and performance standards.
o Maintains close communications with the SAD,and Field Clinical Coordinator (FCC) regarding TSC operations, communications, MTF issues, local network, and Hub.
o Actively participates in meetings and communications with MTF staff.
o Assists the SAD in planning Prime Service Area Executive Council (PSAEC) meetings and participates in those meetings.
o Facilitates special coordination of beneficiary care issues between the MTF, Hub, and TriWest Corporate resources.
o Participates in meetings, studies, and training as directed by the SAD or the Office of the Vice President Operations.
o Maintains ongoing communications with the MTF Referral Management Center and/or MTF TRICARE Operations staff to resolve identified referral and authorization issues.
o Identifies and reports potential risk management and quality of care issues to the SAD, VP, FCC and/or Hub medical management staff, as indicated.
o Provides information to the MTF and Hub on the availability of local area healthcare resources and programs available for provision of TRICARE related services and assistance to Military Health System (MHS) beneficiaries.
o Participates in performance improvement activities.
o Participates as a team member with Health Care Services regarding Referral Processing, Utilization Management (UM), Case Management (CM), and Integrated Behavioral Health (IBH) initiatives.
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o Collaborates with the MTF staff to identify and refer patients for potential CM, DM, or other services, as indicated
o Performs other duties, as assigned.
o Regular and reliable attendance is required.

Skills / Requirements

Education & Experience

Required:
o Registered Nurse with a current, valid, unrestricted nursing license in the state in which the individual will work; BSN preferred
o Five (5) years of varied clinical nursing experience
o Three (3) years of documented supervisory experience
Preferred:
o Working knowledge of TRICARE and MHS is preferred
Competencies

Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.
Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
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.
Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.
Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.
Technical Skills: Ability to utilize ICD-9CM, CPT-4, and HCPCS codes to research referral and authorization and claims issues; Knowledge of the business relationships between network providers, beneficiaries

DoD Statement

You are applying for a position that involves working on electronic systems that have access to Department of Defense ('DoD') systems. Therefore, you must undergo a DoD background investigation. This requires you to submit an application describing the previous 7 years of your life and to provide proof of U.S. citizenship in the form of a certified birth certificate, certificate of naturalization, current passport, form FS-240 or form DS-1350. This process takes several months to complete. During this time, the DoD will grant interim access to U.S. citizens allowing them to work for TriWest until their background investigation is completed. However, the DoD will not authorize interim access for non-U.S. citizens. If you are unable to obtain interim access or pass the background investigation, you are not qualified for this position and TriWest will withdraw any offer of employment or terminate your employment immediately.