Profile
We offer remote work opportunities (AK, AR, AZ, 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).
Veterans, Reservists, Guardsmen and military family members are encouraged to apply!
Job Summary
Coordinates care between VA and community providers for Veterans being evaluated for transplant and monitors case while on the wait list. Calls Veterans for Quality improvement projects, while assessing potential Case Management needs. Reviews BH clinical documentation, using specific clinical criteria to determine potential High Risk cases. Contacts Veterans with recent oncology authorizations, to determine if they need any assistance with their diagnosis. Uses clinical judgement to make a determination as to whether to request the Veteran be referred to Case Management
Education & Experience
Required:
- Registered Nurse, with current unrestricted license in appropriate state or territory of the United States
- 2+ years’ experience in clinical nursing experience
- Proficiency in medical data entry, written skills and Microsoft Office
- Exceptional oral communication skills, strong organizational skills and easily adapts to change
Preferred
- 3 years’ clinical experience
- 2+ years’ Managed Care experience
Key Responsibilities
- Utilizes clinical and analytical skills to identify and refer cases to Case Management
- Communicates with providers, Veterans, VAMCs and facilities to coordinate care for Veterans identified for transplant
- Conducts post service calls to Veterans who have been transplanted
- Conducts complex authorizations for Veterans requiring transplant
- Supports the BH team with clinical chart reviews to identify Veterans that require early appointing o Participates in Clinical Quality improvement projects
- Participates in team knowledge presentations
- Identifies and reports potential quality or fraudulent cases to Internal Audit & Corporate Compliance department or Clinical Quality Management for review
- Participates in focus group studies as requested, including the development and implementation steps
- Supports other regional hubs as needed
- Perform other duties as assigned
- Regular and reliable attendance is required
Competencies
Commitment to Task: Ability to conform to established policies and procedures; exhibit high personal motivation.
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.
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. Ability to accept change and maintain a positive team atmosphere.
Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, with empathy and compassion for another’s position.
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.
Technical Skills: Thorough knowledge of internal policies and procedures, Utilization Management principles, Managed Care concepts, medical terminology, and medical management on-line system, Clinical Decision Support Tool, International Classification of Diseases, and Current Procedural Terminology. Ability to exceed production standards in compliance with contract.
Working Conditions
Working Conditions
- Availability to work any shift
- Works within a standard office environment, or work from home
- Extensive computer work with prolonged 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 on the specific role and location, but generally this position ranges from around $83,000 – $88,000 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.