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

The Director of Medical Documentation Optimization provides strategic, operational, and automation leadership for the design, development, and implementation of TriWest's medical documentation program in full compliance with VA Community Care Network (CCN) contract standards. Reporting to the Vice President of Referral Management and operating with a high degree of autonomy, this role serves as the clinical systems subject matter expert responsible for driving efficiency, accuracy, and scalability across all documentation workflows. The Director leads the IT cross-functional dyad model, partnering closely with Information Technology to identify, prioritize, and execute automation and AI-enabled solutions that enhance program performance and reporting capabilities. The scope of this position is enterprise-wide, with direct accountability for documentation inventory management, productivity targets, staff development, and VA contract compliance. The work of this role directly affects TriWest's ability to fulfill its obligations under the CCN contract, impacts community care access for Veterans, and shapes operational integration across Referral Management and affiliated departments.

Education & Experience

Required:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field; or equivalent experience.
• Five or more years of progressively responsible leadership experience optimizing clinical workflows, including automation and AI-enabled solutions, in a managed care or health care operations environment.
• Demonstrated expertise as a clinical systems subject matter expert, including developing business requirements with IT partners for medical management functions such as referral management, utilization management, or documentation program design.
• Knowledge of VA CCN or federal health care contract standards, including compliance requirements governing documentation timeliness, accuracy, and audit readiness.

Preferred:

• Experience supporting system interoperability, including EHR and HIE integrations.
• Registered Nurse with current unrestricted license in the state in which the successful candidate resides.
• Medical records or clinical documentation improvement experience.
• Knowledge of Military Health System and/or Veterans Administration programs.

Key Responsibilities

• Serves as the clinical systems subject matter expert responsible for designing, developing, and implementing TriWest's medical documentation program; incorporates automation and AI-enabled solutions to drive efficiency, strengthen reporting capabilities, and ensure accuracy and contract compliance across all documentation workflows.
• Leads the IT cross-functional dyad model, providing strategic direction over all medical documentation functions enterprise-wide, including planning, staffing, technology roadmap development, and operational oversight; partners with IT leadership to translate business requirements into system enhancements and automation opportunities.
• Develops and executes strategies for achieving TriWest's medical documentation processing goals and VA CCN contract objectives; establishes measurable performance targets, monitors outcomes, and adjusts operations in response to audit findings, contract changes, or organizational priorities.
• Develops, implements, and maintains medical documentation workflows, policies, desk procedures, and quality standards; ensures all processes meet federal contract requirements and internal accreditation standards. • Reviews audit results, performance data, and inventory reports; identifies trends, root causes, and process gaps; adjusts workflows and operational procedures to sustain or improve performance against targets.
• Creates annual strategies for performance improvement; develops and administers performance management metrics for the department, including individual and unit-level productivity and quality measures.
• Manages and supports administration of the department budget; monitors expenditures, identifies efficiencies, and ensures resource allocation aligns with operational priorities.
• Leads, coaches, and develops departmental staff through a subordinate manager; sets clear performance expectations, provides ongoing feedback and development opportunities, and ensures an effective performance evaluation system is in place.
• Oversees the development and implementation of staff training programs; monitors training effectiveness and adjusts content to address operational changes, system updates, or compliance requirements.
• Actively participates in cross-functional teams and collaborates with department leaders across Referral Management, Quality, Compliance, IT, and other functions to establish shared performance metrics, advance business strategy, and apply industry best practices. • Provides leadership toward meeting the accreditation and regulatory needs of the organization; serves as a subject matter resource for documentation-related compliance matters in interactions with VA contracting officers, auditors, and internal governance bodies.
• Maintains personal contacts with IT partners, VA and government program representatives, internal department directors, external vendors, and community care providers to advance program goals, resolve operational issues, and ensure alignment on documentation standards and performance expectations.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring: Actively develops staff capability through ongoing, constructive feedback, targeted coaching, and structured development opportunities; champions a culture of continuous learning; monitors training effectiveness and adjusts approaches to align with operational and contract requirements.

Commitment to Task: Demonstrates sustained focus and follow-through on complex, long-horizon program objectives; maintains performance standards under competing priorities and contract-driven timelines; holds self and team accountable for delivering results.

Communication / People Skills: Communicates clearly and effectively across all levels of the organization and with external stakeholders including VA representatives, IT partners, and community care providers; adapts communication style to audience; conveys complex technical and operational information in accessible terms; builds trust and credibility through transparent, consistent communication.

Computer Literacy: Proficient in clinical documentation systems, EHR platforms, automation tools, and management reporting applications; functions effectively in a multi-system environment including Microsoft Office Suite, TriWest intranet, and department-specific software; ability to gather, structure, and facilitate meaningful analysis of operational data.

Creativity / Innovation: Generates and champions new approaches to documentation workflow design, automation implementation, and program improvement; applies innovative thinking to identify technology solutions and process enhancements that advance efficiency, accuracy, and contract performance.

Delegation Skills: Effectively assigns responsibilities and work to the appropriate level; maintains appropriate oversight without micromanaging; builds team capability by leveraging individual strengths and developing subordinate decision-making capacity.

Empathy / Customer Service: Maintains a customer-focused orientation in all interactions with internal stakeholders and external partners; demonstrates active listening, patience, and respect; understands the downstream impact of documentation quality on Veteran access to care and applies that perspective to drive program accountability.

Independent Thinking / Self-Initiative: Operates with a high degree of autonomy under the general direction of the VP, Referral Management; identifies issues, initiates solutions, and drives outcomes without requiring close supervision; resourceful in navigating ambiguity and novel operational challenges.

Information Management: Ability to manage large volumes of complex documentation, performance, and compliance data; synthesizes information from multiple systems and sources to draw sound conclusions and support leadership decision-making; maintains organized, audit-ready records and reporting.

Leadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department.

Organizational Skills: Ability to organize people, systems, and tasks across a complex, multi-stakeholder environment; adjusts priorities in response to shifting contract requirements, audit cycles, or operational demands; detail-oriented with strong follow-through on commitments.

Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.

Team-Building / Team Player: Influences the actions and perspectives of others in a constructive direction; builds cohesion and shared purpose within the department and across cross-functional teams; fosters a collaborative environment that supports the IT dyad model and enterprise-wide operational integration.

Technical Skills: Thorough knowledge of health care delivery, managed care concepts, VA CCN contract standards, clinical documentation systems, and EHR/HIE interoperability principles; ability to evaluate and implement automation and AI-enabled solutions; skill in performing critical, in-depth analysis of documentation workflows, medical records, and management reporting tools to assess program performance and referral activity appropriateness.

Working Conditions

Working Conditions:

• Works non-regular hours, as required
• Works within an office environment, travel required
• 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 $154, 000 to $162, 00 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.