Supervisor Case Management-registered Nurse
TriWest Healthcare Alliance (San Diego, California)

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COMPANY OVERVIEW TriWest Healthcare Alliance, headquartered in Phoenix, Arizona, manages and administers quality healthcare services for our nation's active and retired uniformed military service members and their families, through a contract with the Department of Defense. These individuals are eligible for the DoD's regionally managed health care program for the military, called TRICARE. TriWest manages and administers TRICARE throughout the 21-state TRICARE West Region. In addition to supporting military families through the TRICARE program, TriWest has developed relationships with organizations such as the USO, Fisher House, the Women in Military Service for America Memorial Foundation and other military relief and support associations to strengthen America's military community locally and nationally. TriWest provides state-of-the-art facilities, a smoke/tobacco-free, drug-free, business casual working environment, and offers a competitive compensation package including excellent benefits. For more information about TriWest, please explore our website at www.triwest.com. 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. JOB SUMMARY/DESCRIPTION Job Summary: Under the direction of the Hub Manager and Director of CM, supervises the Hub Case Managers practice and implements the CM program. Participates in the hiring, firing, orientation, training and coaching of CM staff. Assigns and reassigns staff caseload. Monitors and evaluates the Case Managers delivery of CM services, productivity and quality. Provides direction to Case Managers on problematic and complex cases. Ensures CM services and staff are compliant with TriWest CM program requirements, TRICARE policy, TriWest policy, and Health care Services (HCS) desk procedures. Assesses clinical, psychosocial and learning needs of beneficiaries. Provides CM services and manages an individual caseload. Key Areas of Responsibility Directly supervises the hub CM clinical and non-clinical staff; managing the day-to-day activities of the CM services. Participates in the hiring, firing, orientation, training and coaching of CM staff. Provides performance evaluations for staff. Encourage Case Manager¿s professional development. Assists Clinical Hub Manager with recruitment efforts to ensure all Hub CM staff positions are appropriately staffed. Develops, implements and supervises new and existing staff training. Ensures staff are adequately trained to provide CM services following the CM standards of practice, within their professional scope of practice and compliant with policy and procedures. Documents training that each employee has received. Prepares job aids; coaches and counsels staff. Ensures training programs¿ effectiveness; develops, implements, and supervises new and existing staff training. Serves as subject matter expert for the CM program and related quality management processes at the hub. Conducts regular case review audits to evaluate Case Manager practice quality, timeliness and process consistency. Conducts ad hoc audits in response to special needs. Provides feedback to staff regarding case review results and areas needing improvement. Provides leadership in the development and implementation of quality assurance programs for the Hub to meet and exceed all service level CM (CM) requirements. Reviews individual staff caseload and beneficiary treatment plans. Reassigns cases as necessary. Carries a CM caseload when necessary. Oversees the delivery of specialty programs administered in the hub and ensures compliance with policy and HCS desk procedures. Participates in clinical and non-clinical performance improvement projects in support of URAC accreditation. Collaborates with the Director of CM and CM Medical Director to implement the TriWest Catastrophic CM program, refine and revise program processes, policy and procedures, and evaluate program effectiveness. Participates in the evaluation of the effectiveness and efficiency of the CM program. Monitors Hub CM operations performance in collaboration and communication with the Director of CM and the Hub Clinical Manager; Working Conditions: be available to cover any day work shift Sitting for extended periods of time Heavy use of computer Minimal travel required Department of Defense (DoD) security clearance required Competencies: Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; Has a realistic understanding of relevant issues Communication/People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching Coping/Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach 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 Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications QUALIFICATIONS Education and experience for this position include the following and are required: current unrestricted Registered Nurse license (RN) recognized as valid by the applicable state licensure board where the position is located. At least one of the following: Bachelor's (or higher) degree in a health-related field and licensure as a health professional (where such licensure is available) Certification* as a Case Manager Professional certification in a clinical specialty and at least three (3) years experience as Case Manager Five (5) years of medical-surgical/behavioral health clinical experience or equivalent. Three (3) years of previous CM experience or equivalent. Certification* as a Case Manager within three (3) years of accepting the Supervisor position. Knowledge, Skills and Abilities: Practices CM within the scope of their professional licensure Applies ethical guidelines as outlined in the individual¿s professional licensure and certifications Strong knowledge of the principles and strategies of CM and CM Standards of Practice Strong understanding of community resources, treatment options, funding options, and special programs Knowledge of utilization management (UM), managed care concepts, cost benefit principles, market community resources and alternative funding programs including military resources Knowledge of Interqual, DRGs, ICD-9, CPT-4 and HCPCS. Working knowledge of HIPAA and state rules and regulations regarding PHI Strong critical thinking, priority-setting, organizational, and time management skills Demonstrated management and leadership skills Excellent interpersonal skills and the ability to work effectively and independently. Excellent verbal and written communication skills Excellent team building skills Proficiency in Microsoft Office applications and the Internet Demonstrated ability for assessment, evaluation and interpretation of medical work Exceptional ability to prioritize/organize workload, multi-task, problem solve and make decisions Demonstrated ability to achieve desired results Works exceedingly well in a fast-paced environment BENEFITS TriWest offers a comprehensive and progressive benefits package that includes: o Medical, dental and vision coverage o Generous paid time off o 401(k) Retirement Savings Plan (with matching) o Short-term and long-term disability, basic life, and accidental death and dismemberment insurance o Voluntary plans such as pet insurance, long-term care and 529 College Savings Plans o Reimbursement for various wellness initiatives o Tuition reimbursement EQUAL EMPLOYMENT OPPORTUNITY TriWest Healthcare Alliance is an equal employment opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.