Description

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

Reporting to the Director, Clinical Performance, this role will collaborate and consult with leaders to drive process excellence and program execution for critical clinical initiatives. They will support work to standardize and optimize work across all operational departments within Clinical Operations Case Management (including special programs) and Care Coordination, Utilization Management, Pop Health/Disease Management, and Clinical Quality Management). This position plays a key role in identifying and assessing innovative approaches and technologies and facilitating cross-departmental collaboration to drive high-quality clinical performance across all applicable metrics.

Education & Experience

Required:

• Bachelor's Degree in a health profession field or business or equivalent experience
• Must be a U.S. Citizen able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Demonstrated success in process documentation and mapping health care operations' workflows
• Advanced in MS Office to include mapping tools such as Visio
• Experience with healthcare performance improvement techniques (DMAIC, FOCUS-PDSA, or similar)
• Excellent communications and consultative skills

Preferred:

• Master's degree or equivalent in healthcare related field, or Business or Health Care Administration
• Thorough knowledge of TRICARE programs
• Experience with formal project management techniques (PMP, Lean Six Sigma, etc)

Key Responsibilities

• Collaborates with all Clinical Operations Directors and Medical Directors in documentation, assessment and enhancement of critical business processes, with a focus on mitigating risks, reducing inefficiencies and enhancing process control.
• Delivers end-to-end process mapping and gap analysis to support a consistent operations model. Provides analyses on gaps, redundancies and inefficiencies and makes recommendations to leadership.
• Leverages tools and technologies to improve documentation quality and reduce manual work.
• Collaborates with directors to identify metrics and outcomes to optimize workflow and workforce management processes. Facilitates clinical process improvement efforts with working groups or clinicians.
• Aligns cross-department program objectives with TriWest's strategic priorities and CAP (Corrective Action Plan)/ Quality Improvement Project (QIP) goals.
• Applies clinical or clinical-adjacent expertise to optimize processes, improve compliance, and support clinical programs.
• Provides direct mentorship to clinical leadership and front-line clinical staff regarding strategies and solutions for workforce and workflow optimization.
• Promotes a culture of accountability, collaboration, and professional growth.
• Partners with the Clinical Training teams to ensure staff maintain current licensure on required crisis intervention training in their respective roles.
• Active participant in Clinical Operations committees as the lead for integrated processes.
• Perform other duties as assigned.
• 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, Teams, SharePoint, and medical management 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.

Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.

Leadership: Achieves authority from demonstrated knowledge and expertise to influence 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.

Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.

Technical Skills: Advanced knowledge of clinical workflow processes and clinical improvement techniques; advanced knowledge of managed care principles, Utilization, Case and/or Disease Management programs and demonstrated high level presentation skills.

Working Conditions

Working Conditions:

• Availability to cover any work shift
• Works within a standard office environment, with moderate travel
• Extensive computer work with long periods of sitting
• Regular and reliable attendance

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 $125,000 - $139,000 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.