TriWest Healthcare Alliance
Manager, CM Special Programs (Autism Care Demonstration)
TriWest Healthcare Alliance, Phoenix, Arizona, United States, 85003
Overview
Manager, CM Special Programs (Autism Care Demonstration) role at TriWest Healthcare Alliance. Responsible for leading and managing a team of clinical and non-clinical staff in providing benefit administration, prior authorization and care coordination for TRICARE beneficiaries eligible for ECHO benefits and the Autism Care Demonstration/Programs. Under direction from the Director of Case Management (CM), the Manager develops and implements program components to optimize CM and Care Coordination strategies and policies to ensure compliance with contract standards. Education & Experience
Required: Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), or Board Certified Behavioral Analyst with current BACB board certification with current unrestricted licensure Bachelor\'s degree in a health-related field with 3 years Medical-Surgical clinical experience or equivalent If supporting TRICARE contract, must be a U.S. Citizen If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Minimum of five years clinical experience with progressively responsible management experience in CM or Care Coordination operations and program development Preferred
Medical Claims, Utilization or Case Management experience Clinical Experience related to children with disabilities, TRICARE ECHO and/or Autism Care programs Key Responsibilities
Direct operational leadership of CM Special Program functions and staff to ensure compliance with contract requirements and adherence to contract deliverables. Monitor day-to-day operations of the CM Special Program team to identify barriers to providing excellent service to beneficiaries. Systematically evaluate the quality and effectiveness of staff performance, analyze data to identify areas of improvement; advise and coach when appropriate and complete annual performance appraisals. Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care. Participate in development of measurable outcomes and ensure measures monitor the impact of programs on the health status of managed beneficiaries. Plan and implement orientation and training of new-hire employees. Ensure adherence to accreditation standards, contract policy, contractual requirements, and nationally recognized practice standards. Participate in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards. Participate in interdepartmental committees and/or workgroups pertinent to areas of responsibility. Performs other duties as assigned. Competencies
Communication / People Skills:
Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another\'s position. Computer Literacy:
Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Delegation Skills:
Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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. Information Management:
Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. 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. 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:
Thorough knowledge of health care delivery, UM, CM, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations. Team-Building / Team Player:
Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills:
Knowledge of TRICARE policies and procedures, Case Management, Utilization Management, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs, medical management systems, and protected health information; proficiency with medical necessity criteria to evaluate care requests; working knowledge of medical coding. Working Conditions
Availability to cover any work shift Remote work environment, with minimal travel required Extensive computer and telephone work with long periods of sitting Benefits
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 - $122,000 per year. Employment Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Project Management and Information Technology Industries: Hospitals and Health Care 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.
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Manager, CM Special Programs (Autism Care Demonstration) role at TriWest Healthcare Alliance. Responsible for leading and managing a team of clinical and non-clinical staff in providing benefit administration, prior authorization and care coordination for TRICARE beneficiaries eligible for ECHO benefits and the Autism Care Demonstration/Programs. Under direction from the Director of Case Management (CM), the Manager develops and implements program components to optimize CM and Care Coordination strategies and policies to ensure compliance with contract standards. Education & Experience
Required: Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), or Board Certified Behavioral Analyst with current BACB board certification with current unrestricted licensure Bachelor\'s degree in a health-related field with 3 years Medical-Surgical clinical experience or equivalent If supporting TRICARE contract, must be a U.S. Citizen If supporting TRICARE contract, must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Minimum of five years clinical experience with progressively responsible management experience in CM or Care Coordination operations and program development Preferred
Medical Claims, Utilization or Case Management experience Clinical Experience related to children with disabilities, TRICARE ECHO and/or Autism Care programs Key Responsibilities
Direct operational leadership of CM Special Program functions and staff to ensure compliance with contract requirements and adherence to contract deliverables. Monitor day-to-day operations of the CM Special Program team to identify barriers to providing excellent service to beneficiaries. Systematically evaluate the quality and effectiveness of staff performance, analyze data to identify areas of improvement; advise and coach when appropriate and complete annual performance appraisals. Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable standards of care. Participate in development of measurable outcomes and ensure measures monitor the impact of programs on the health status of managed beneficiaries. Plan and implement orientation and training of new-hire employees. Ensure adherence to accreditation standards, contract policy, contractual requirements, and nationally recognized practice standards. Participate in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards. Participate in interdepartmental committees and/or workgroups pertinent to areas of responsibility. Performs other duties as assigned. Competencies
Communication / People Skills:
Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another\'s position. Computer Literacy:
Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Delegation Skills:
Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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. Information Management:
Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. 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. 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:
Thorough knowledge of health care delivery, UM, CM, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations. Team-Building / Team Player:
Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills:
Knowledge of TRICARE policies and procedures, Case Management, Utilization Management, Managed Care concepts, Behavioral Health practices and principles, Medicaid and Medicare eligibility requirements and benefits, community resources, alternative funding programs, medical management systems, and protected health information; proficiency with medical necessity criteria to evaluate care requests; working knowledge of medical coding. Working Conditions
Availability to cover any work shift Remote work environment, with minimal travel required Extensive computer and telephone work with long periods of sitting Benefits
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 - $122,000 per year. Employment Details
Seniority level: Mid-Senior level Employment type: Full-time Job function: Project Management and Information Technology Industries: Hospitals and Health Care 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.
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