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

Provides Case Management services for TriWest Veterans. Evaluates referrals and completes a comprehensive assessment. Develops an individualized case management plan of care, implements the care plan and continuously reassesses needs, plan effectiveness and outcomes. Reviews and processes authorization and referral requests according to policy. Case Managers are responsible for reviewing and understanding the scope of practice of their state of licensure.

Education & Experience

Required:
o A current, unrestricted license or certification to independently conduct assessments within the scope of practice for the discipline E.g. Licensed Clinical Social Worker (LCSW) or Registered Nurse (RN) in appropriate state or territory of the United States

o Two years' experience providing direct clinical care

o Obtain a URAC-recognized certification in case management within two (2) years of hire

Preferred:
o 2 years case management experience o Bi-lingual in English and Spanish

Key Responsibilities

o Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice.
o Screens Veteran needs and circumstances with predetermined program criteria to determine appropriateness for case management. Identifies Veterans at high-risk for significant adverse health outcomes and with high-cost, clinical and psychological factors impacting care.
o Documents the process by providing the case management enrollment information to the Veteran. Provides timely decision of acceptance into the case management program and completes appropriate notifications.
o Completes comprehensive case management assessments. Develops individualized case management care plans to assist Veterans with obtaining access to quality care in a cost-effective manner. Obtains necessary agreements for obtaining protected health information as needed.
o Reassesses and monitors care plans for adjustments on a monthly basis to address newly-identified needs, services, treatment, and funding options. Documents changes in the care plan maintained in the medical management system.
o Evaluates case management outcomes, assessing the individual Veteran's satisfaction and compliance with the care plan.

o Prepares and presents cases involving high-profile or sensitive issues to the Medical Director for review.
o Functions as an advocate for the Veteran by ensuring access to necessary care and maintaining Veteran's safety, locating specialized services outside the network by identifying providers, exploring nature of services offered, and facilitating process.
o Supports Veterans by providing VA and community resource information and internal care referrals as needed to meet care plan goals.
o Monitors and provides guidance to administrative staff for delegated activities and provides input into the performance of the administrative staff.
o Regular and reliable attendance is required.

Competencies

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.

Empathy / Customer Service: Customer-focused behavior; Helping approach, including listening skills, patience, respect, and empathy for another's position.

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.

Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.

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.

Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills: Thorough knowledge of Case Management, Utilization Management, 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, medical management system; Proficiency with InterQual ISD® criteria (Intensity of Service/Severity of Illness/Discharge Screens); working knowledge of medical coding.

Working Conditions

Working Conditions:
o Availability to cover any work shift o Extensive computer work with long periods of 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 - $93, 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.