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).

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 and directing a team of clinical and non-clinical staff that provide Clinical Quality Review services and interventions for beneficiaries and providers under the direction of the Director of Clinical Quality Management (CQM). The Manager will lead and guide staff in supporting a robust CQM program that is focused on ensuring all beneficiaries receive appropriate and safe health care services. In collaboration with the Director ofCQM, works to develop and implement clinical program components to optimize safety and quality strategies, goals, policies and procedures to ensure compliance with contract and accreditation standards.

Education & Experience

Required:

• Bachelor's degree in Nursing, Health Administration, health-related field or equivalent education and experience
• Registered Nurse with current unrestricted license
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 5 years' clinical experience in Medical Surgical and Behavioral Health
• 3 years' direct experience in Quality Management and Quality Studies
• 3 years' supervisory experience

Preferred:

• Master's Degree in Nursing or another health-related field
• Certified Professional in Healthcare Quality (CPHQ)
• Experience analyzing large data sets
• Experience writing professional reports
• Experience conducting medical records abstracting and quality investigations
• Knowledge of TRICARE, Medicare, or government health care programs

Key Responsibilities

• Direct operational leadership of CQM functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
• Plans, organizes, and implements collection of data and preparation of reports that support CQM management activities.
• 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.
• Participates in the development of measurable 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.
• Develops and maintains expertise in contract and accreditation requirements as they pertain to CQM.
• Ensure adherence to accreditation standards, TRICARE policy, contractual requirements, and nationally recognized practice standards.
• Participates in development and annual review of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
• Supervision of all multi-functional Peer Review Organization activities carried out by quality staff.

• Responsible for supporting and managing activities and reporting associated with the CM committees.
• Maintains the confidentiality and non-discoverability of all quality issues.
• Ensures appropriate documentation, implementation, and evaluation for corrective actions on defined quality issues are maintained.
• Supervise staff to include interviewing and hiring; planning and implementing orientation and training strategies for new-hire employees; setting and managing expectations, coaching and ensuring team and individual goals are met.
• Assists staff in identifying, developing, and monitoring progress of quality studies and conducting focused reviews.
• Assists staff in timely, concise, and accurate data collection, analysis and reporting of quality issues (verbal and written).
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

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 internal and external applications, and able to utilize internet search capabilities for research.

Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion.

High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.

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.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; have 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: Proficient with the Microsoft Office suite of applications; thorough knowledge of TRICARE policies and procedures; comprehensive knowledge of research methodology that supports evaluation of potential quality issues and/or serious reportable events; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria.

Working Conditions

Working Conditions:

• Remote/virtual environment if preferred
• Availability to cover any work shift
• Ability to travel as needed
• Extensive computer work with long periods of sitting
• Department of Defense security clearance required

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
• 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 $110, 000 to $116, 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.