Case Manager – RN - NV, MN, AK at TriWest Healthcare Alliance in Las Vegas, Nevada

Job Description:

*Must carry an active and unrestricted RN licensure in one of the following states: Nevada, Minnesota, and Alaska*

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

The position provides case management services for TRICARE beneficiaries registered in the Extended Care Health Option (ECHO) under TRICARE. The ECHO is a supplemental program to the TRICARE Basic Program and includes services and supplies to eligible Active Duty Family Members (ADFMs) with serious intellectual or physical disability. These benefits are an additional financial resource, above and beyond what is available under the beneficiary's basic TRICARE plan, offering an integrated set of services and supplies designed to assist in the reduction of the disabling effects of the beneficiary's qualifying condition.

Education & Experience

Required:

• Current unrestricted licensure in an appropriate state or territory of the United States, as a Licensed Clinical Social Worker or Registered Nurse
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Three years full-time equivalent of direct clinical care to the consumer
• Ability to obtain a URAC-recognized certification in case management within four (4) years of hire

Preferred:

• 2 years' experience working with populations with serious intellectual or physical disabilities
• 2 years case management experience
• URAC-recognized case manager certification

Key Responsibilities

• Providing case management services to TRICARE beneficiaries who qualify for the ECHO and ensuring access to equipment or other services as clinically appropriate and according to TRICARE policy.
• Conducts clinical review for requested services particular to the ECHO according to policy, collaborating with Medical Directors as needed.
• ECHO Case Managers serve as subject matter experts regarding the ECHO benefit, as well as having command of the TRICARE basic benefit structure.
• Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.
• Completes comprehensive case management assessments, and develops individualized case management care plans to assist beneficiaries with obtaining access to quality care in a cost-effective manner.
• Coordinates with the Primary Care Manager (PCM) or specialty health providers for information and input into the individualized care plan, and makes that plan available to all interested parties.
• Reassesses and monitors care plans for adjustments monthly, at a minimum, to address newly identified needs, services, treatment, and funding options. Documents activity and implements changes in the care plan maintained in the medical management system.
• Evaluates case management outcomes, assessing the individual beneficiary's satisfaction and compliance with the care plan.
• Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review.
• Functions as an advocate for the beneficiary by ensuring access to necessary care and maintaining the beneficiary's safety, locating specialized services outside the network by identifying providers, exploring the nature of services offered, and pricing or service delivery options.
• Supports beneficiaries by providing TRICARE and community resource information and internal care referrals as needed to meet care plan goals.
• Screens for high risk factors indicating appropriateness for complex case management services from a non-ECHO case manager.
• Maintains knowledge of and compliance with URAC Foundational Standards and department norms.
• Monitors and provides direction to non-clinical staff.
• Regular and reliable attendance is required.
• Other duties as assigned and applicable.

Competencies

Communication / People Skills: Capacity to effectively influence and persuade individuals in diverse situations, adapt communication styles to varying contexts, actively listen, critically analyze information and foster collaboration.

Computer Literacy: Proficiency in navigating and utilizing various Microsoft application, including word and Outlook, as well as departmental specific software and internet-based tools within a multi-system environment.

Coping / Flexibility: Capable of navigating through diverse situations and interacting effectively with individuals, while maintaining a sense of purpose and employing mature problem-solving skills, demonstrating adaptability and resilience.

Empathy / Customer Service: Customer centric approach that ensures patience, respect, attentive listening and empathy toward the perspective of the customer.

Independent Thinking / Self-Initiative: Resourceful critical thinker who can prioritize tasks essential to achieving desires outcomes, demonstration of a proactive commitment to task completion and the ability to identify and secure necessary resources.

Multi-Tasking / Time Management: Proficient in prioritizing and managing task to meet evolving deadlines and requirements amidst a demanding and fast-paced environment characterized by high volume and stress.

Organizational Skills: Skilled in coordinating people and tasks, adeptly adjusting to changing priorities, mastering systems efficiently within time constraints, and utilizing available resources with attention to detail.

Problem Solving / Analysis: Proficient in problem-solving through systematic process analysis, guided by sound judgment and grounded in a practical grasp of pertinent issues.

Team-Building / Team Player: Able to influence the actions and opinions of others in a positive direction and build group engagement.

Technical Skills: Thorough knowledge of Case Management, Utilization Management, TRICARE policies and procedures, HIPAA Privacy and Security regulations, URAC accreditation standards, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs and medical management system. Proficiency if basic medical coding principles.

Working Conditions

Working Conditions:

• Ability to cover any work shift
• Ability to work overtime, if needed
• Onsite: Works within a standard office environment
• Remote: Private and secure workspace and workstation with high speed internet is required
• Extensive computer work with prolonged sitting, wearing of headset, typing, speaking on a phone

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

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.