Job: Hub Clinical Manager-Registered Nurse

COMPANY OVERVIEW
TriWest Healthcare Alliance, headquartered in Phoenix, Arizona, manages and administers quality healthcare services for our nation's active and retired uniformed military service members and their families, through a contract with the Department of Defense.

These individuals are eligible for the DoD's regionally managed health care program for the military, called TRICARE. TriWest manages and administers TRICARE throughout the 21-state TRICARE West Region.

In addition to supporting military families through the TRICARE program, TriWest has developed relationships with organizations such as the USO, Fisher House, the Women in Military Service for America Memorial Foundation and other military relief and support associations to strengthen America's military community locally and nationally.

TriWest provides state-of-the-art facilities, a smoke/tobacco-free, drug-free, business casual working environment, and offers a competitive compensation package including excellent benefits.

For more information about TriWest, please explore our website at www.triwest.com.

DOD STATEMENT
You are applying for a position that involves working on electronic systems that have access to Department of Defense ('DoD') systems. Therefore, you must undergo a DoD background investigation. This requires you to submit an application describing the previous 7 years of your life and to provide proof of U.S. citizenship in the form of a certified birth certificate, certificate of naturalization, current passport, form FS-240 or form DS-1350. This process takes several months to complete. During this time, the DoD will grant interim access to U.S. citizens allowing them to work for TriWest until their background investigation is completed. However, the DoD will not authorize interim access for non-U.S. citizens. If you are unable to obtain interim access or pass the background investigation, you are not qualified for this position and TriWest will withdraw any offer of employment or terminate your employment immediately.

JOB SUMMARY/DESCRIPTION
Job Summary:
Responsible for clinical operations in the Hubs, including Clinical Review, Care Coordination and Case Management for Medical/Surgical and Integrated Behavioral Health (IBH) cases. The Hub Clinical Manager ensures medical management programs adhere to TRICARE program requirements, TRICARE Management Activity (TMA) directives, Health Care Services (HCS) policies and procedures, and TriWest's mission and values.
The Hub Clinical Manager reports to and collaborates with the Hub Clinical Director and corporate HCS Directors to enhance medical management programs by identifying market-specific requirements. This position is responsible for clinical training activities in the Hub by providing direction to the team coordinator, supervisors and staff. The Hub Clinical Manager also collaborates with and provides support to TriWest Customer Service, Field Clinical Coordinators (FCCs and CLNs), Military Treatment Facilities (MTFs), staff, and Medical Management Support Office (MMSO) to promote superior customer service and ensure operations meet production and quality standards.

Key Responsibility Areas:
o Provides leadership to ensure operational effectiveness and efficiency of managed care activities meet and exceed service-level goals and contract requirements.
o Provides coaching and oversight to staff to ensure staff success and development.
o Reports significant issues to the Clinical Director and the Market Vice President, keeping informed of issues with UM, CM, Integrated Behavioral Health (IBH), quality of care, fraud and abuse, and provider availability to render services that affect clinical operations, HCS, the Markets, and TriWest.
o Promotes and supports clinical quality management programs to include training and staff development to ensure professional, accurate, and timely customer service. Actively participates in the CCQMC meetings, as assigned.
o Leads the Hub's recruitment efforts and achieves fiscally-responsible resource management.
o Manages and monitors training, including department-specific and on-the-job training components. Along with team coordinator, provides staff refresher training, one-on-one training, and assists the Clinical Director with leadership development training. Works with Leadership Development and Training (LD&T) to update existing classes and adds classes as necessary.
o Keeps staff informed of TriWest internal changes and events and external issues impacting TriWest's mission and goals. Coordinates, plans, and conducts team meetings.
o Provides support to non-clinical staff regarding clinical and coding questions.
o Develops and implements enhanced systems and processes to improve Hub operational performance metrics and delivery of care. Monitors ongoing compliance with contract standards for timeliness and quality

QUALIFICATIONS
Education & Experience:
o Registered Nurse with current unrestricted license
o Bachelor's Degree in Nursing or Master's Degree in Nursing, Health Administration or related field
o Two years or more of supervisory or managerial experience
o Five years clinical experience
o Extensive managed care and operational experience in medical management systems, including utilization management (UM) or case management (CM)
Preferred
o Prior TRICARE experience
o Qualifications for UM and CM certifications
o Experience with the Military Health System (MHS)

BENEFITS
TriWest offers a comprehensive and progressive benefits package that includes:

o Medical, dental and vision coverage
o Generous paid time off
o 401(k) Retirement Savings Plan (with matching)
o Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
o Voluntary plans such as pet insurance, long-term care and 529 College Savings Plans
o Reimbursement for various wellness initiatives
o Tuition reimbursement