Director, Referral Management (Finance)

We offer remote work opportunities (AK, AR, AZ, CA, *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!

Must be U.S. Citizen.

Job Summary

Under the direction of the Vice President, Referral Management, this position is responsible for the system-wide development, oversight, direction, evaluation and implementation of the Referral Management Program and staff in support of the T-5 TRICARE West Region contract. The Referral Management department processes Referrals and Authorizations (R/A) according to contract standards. In collaboration with our Military & Veteran Services (MVS) leadership team and the Clinical Operations Utilization Management team, the Director develops strategies for achieving annual Referral Management goals and objectives, including input on system configuration and process development. This position directs referral management, optimization and clinical documentation return processes to meet or exceed contract requirements and corporate objectives. This includes overseeing referral/authorization inventory, staff workload, and directs the Managers of Referral Processing to optimize operational performance of staff including consultation on performance management, productivity, quality and timeliness of R/As, attendance, quality training and education. This Director also collaborates with other stakeholder teams to achieve TriWest performance standards and other contractual requirements.

Education & Experience

Required:

• Bachelor's Degree in Business Administration, Health Care Administration or related field or equivalent experience
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Five years of progressively responsible referral management and leadership experience that includes program design and development to meet performance metrics and goals
• Knowledge of Military Health System and/or TRICARE program
• Knowledge of medical management, including referral management and utilization management

Preferred:

• Master's Degree in Business or related field
• Military affiliated to include Veterans and/or military spouses

Key Responsibilities

• Direct the overall operational leadership of Referral Management (RM) functions and staff to ensure compliance with contract requirements and adherence to contract deliverables.
• Develops strategies for achieving TriWest's referral management objectives.
• Oversee development, implementation, and timely updates to Referral Management department policies, procedures, and guidelines.
• Coordinate with clinical operations to educate and communicate expectations with providers.
• Creates annual referral management strategies, develops performance management metrics, and oversees the management of reporting.
• Work with executive leadership to ensure targets are met for the annual operating plan/financial management.
• Collaborates with Utilization Management Director, MVS Directors, network providers, Military Treatment Facilities and TRICARE Regional Office West regarding TriWest's RM program initiatives including submission, review, optimization and return of clinical documentation processes.
• Participates in cross-functional teams to enhance business strategy, process improvement, and use of industry best practices related to referral management.

• Develops and implements training programs for Referral Management department staff and monitors effectiveness of staff training initiatives.
• Ensures an effective performance evaluation system is implemented, including appropriate feedback to staff, motivation, and opportunities for growth and development.
• Contributes to assessment and enhancements of the referral management/medical management systems
• Performs other duties as assigned.

Competencies

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

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

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.

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.

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: Knowledge of managed care and/or TRICARE and the Military Health System (MHS).

Working Conditions

• Works non-regular hours, as required
• Works within an office environment, travel required
• Extensive computer work with prolonged 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.

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

*Annual base salary for Colorado, Hawaii, Washington D.C. and Washington State residents: $159,000 - $177,000 depending on experience*

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.