Job Summary

Serves as TriWest's primary representative to the Military and Veterans' Services Administration (VA) healthcare facilities within a specified geographic area relating to TriWest contracted services for the VA Community Care Network (CCN) and the Department of Defense (DoD) TRICARE West Region managed care support contract. The incumbent will perform account management services and be responsible for building collaborative relationships with, resolving issues for, and identifying optimization opportunities to improve the experience of the supported healthcare facilities and respective staffs, network providers, and VA and DoD healthcare beneficiaries within their assigned service area of responsibility. The incumbent serves as the primary point-of-contact (POC) for bringing the collective TriWest corporate functions together in support of the facilities, contracted provider network, and beneficiary community support needs. The position reports to the assigned Vice President in the Military and Veteran's Services organization.

Education & Experience

Required: Bachelor's degree in Health Care Administration, Business, or related field 7 years of middle to senior management experience, with increasing responsibility 3+ years of recent healthcare experience Strong customer service orientation

Preferred: Master's degree in Health Care Administration, Business, or related field Knowledge of the business relationships between health plans and network providers, health plan beneficiaries/members, and managing contract performance matters Prior experience and management-level work in VA healthcare, MTFs, and TRICARE Managed Care experience and working with contract performance requirements

Key Responsibilities

Develops and maintains a clear understanding of TriWest's contracted responsibilities and performance requirements of the VA's Community Care Network and the DoD's TRICARE West Region managed care support contract. Maintains ongoing communications and functions as the primary TriWest POC for the assigned medical facility leadership and their staffs regarding services and support provided by TriWest departments. Meets with medical facility leadership on a monthly basis to gauge ongoing support, adjust to capabilities and capacity changes, prepare for contingencies, identify issues and challenges, and assess other ongoing needs. Educates medical facility staff regarding TriWest processes and systems and provides direct support and assistance to them regarding business plan development and updates. Develops proposals for improved healthcare delivery and care coordination between the medical facilities healthcare system, and community healthcare. Supports the integration of referral management, medical management, provider services, and claims with the provider network.

Develops, monitors compliance, initiates changes as needed, and annually reviews the Memorandum of Understanding (MOU) and Statement of Responsibility, if required, with each DoD medical facility in their assigned regional area of responsibility. Oversees beneficiary education activities and supervises and supports the Beneficiary Education and Services Representative(s) within their assigned regional area of responsibility. Plans and facilitates TriWest participation and response to MTF contingency exercises. Prepares reports as needed to provide description, assessment, and lessons learned per contract requirements. Maintains liaison with State Adjutants General, National Guard and Reserve Commanders and their organizational and medical staff within the assigned regional area of responsibility as well as the National Oceanic Atmospheric Administration (NOAA) Public Health Service regarding the provision of TRICARE education and s

.: Maintains liaison with Special Operations Commands, their Command Surgeons and key medical staff within each command to gain early awareness of upc ming deployments or redeployments to identify any wounded, ill, or injured service members who need expedited facilitation of their healthcare needs, and to identify any special family medical support requirements. The incumbent will alert relevant TriWest staff regarding any immediate or ongoing specific medical needs of Special Operations commands and any specific administrative support needs (behavioral health issues, authorizations, claims, or other specialized referrals). The incumbent will also establish and maintain liaison with key representative of Special Operations family support groups and other organizations/foundations dedicated to support Special Operations. Performs other duties as assigned. Regular and reliable attendance is required.

Monitors, evaluates, and advises leadership regarding TriWest's performance of customer service, contract requirements and the quality and effectiveness of integrated operations between the direct care system and provider network. Serves as a member of the TRICARE Readiness, Integration, and Delivery (TRIAD) team and as TriWest's primary representative to medical facility leadership and their staffs and the TRICARE beneficiary communities within a specified geographic Service Area. Functions as an advisor to medical facility leadership regarding updates for network adequacy, to the MTF Capability and Capacity Tool, and how TriWest may assist in supporting the medical facility staff Knowledge Skills and Abilities (KSAs) and optimization objectives and to identify any upcoming changes that may require adjustments to the network, as appropriate. If changes are required, the incumbent will work with medical facility leadership and TW staff to update KSAs in the TriWest MTF Optimization...

Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity