We offer remote work opportunities in CA for this role.
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
The Referral Management Program Manager is responsible for advising on the design and planning of TriWest’s TRICARE (T-5) referral and authorization processing operation. The Program Manager will help to facilitate direction in all aspects of building and optimizing the referral and authorization processing operation to include organizational design, workflow design, inventory management, staffing, systems development, stakeholder engagement, performance metrics, reporting and staff onboarding/training.
Education & Experience
Required:
• Bachelor's degree in Business Administration Health Care Administration or similar degree; OR equivalent experience
• 5+ years management level experience in TRICARE referral and authorization management
• Must be a U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Proven ability to execute across internal and external stakeholder groups
• Experience working on and influencing teams to produce desired outcomes
• Experience with the Microsoft Product Suite
Preferred:
• Experience with data analysis, statistical analysis, process flow mapping and report design, including proficiency with database querying
Key Responsibilities
• Serves as a subject matter expert to support building out the referral and authorization processing operation. This will include program design, organizational design, staffing, workflow design, inventory management, system development review, reporting and staff onboarding.
• Supports the development, implementation and updates to department policies, procedures and guidelines.
• Assists with interviewing and selection of staff.
• Collaborates to set performance metrics and how production and performance will be measured.
• Assesses the impact of government contract requirements and specific business initiatives on operations and works towards operationalizing changes.
• Identifies and communicates opportunities for redefinition of operational and management processes based upon application of best practices in order to improve operations effectiveness and efficiency.
• Participates in systems development, performance and improvements.
• Advises on interdependency engagements – internal and external partners. As needed, interacts with government points-of-contact on referral-related issues.
• Helps develop referral and authorization training materials.
• Assists with special projects and other duties, as assigned by TriWest Senior Leadership.
Competencies
Communication / People Skills: Clearly presents information through spoken or written communication; effectively reads others and adapts communication patterns to multiple individual styles; demonstrates ability to influence or persuade others in positive or negative circumstances; ability to listen critically for relevant information; clearly demonstrate respect for others.
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.
Independent Thinking / Self-Initiative: Critical thinker 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.
High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow.
Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.
Organizational Skills: Detail-oriented; ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources.
Team-Building / Team Player: Ability to influence the actions and opinions of others in a positive direction and build group commitment; adapt to different styles; listen critically; collaborate.
Technical Skills: Advanced knowledge of Microsoft Word, Excel, and PowerPoint; ability to function without direction to produce outcomes within timelines; proficiency with project management skills, data analysis, and quality improvement concepts; collaboration skills and team-oriented approach; presentations and meeting facilitation skills.
Working Conditions
Working Conditions:
• Availability to work non-regular hours, including weekends, as required
• Works within a standard office environment, with up to 30% travel
• Extensive computer work with long periods of sitting