Market/MTF Opt Plan Mgr

Profile 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 reputed company 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 Supports Military Medical Treatment Facilities (MTFs) in optimizing opportunities for military medical personnel to reputed company or maintain the clinical knowledge, skills, and abilities (KSAs) desired in a deployed environment. The incumbent reviews and analyzes MTF reported capacities and capabilities along with their prioritized CPT and ICD-10 codes that provide their medical personnel with the clinical experiences to reputed company or maintain their readiness goals. The manager also analyzes network referral and claims data to identify business opportunities that optimize MTF capabilities and reputed company, and collaborates with internal departments to strategically reputed company the network and identify community providers that can assist in supporting these readiness goals. The incumbent maintains a database for each geographic area that tracks MTF capabilities and capacities, and their reputed company CPT and ICD-10 codes, which they utilize to reputed company recommendations for internal and external stakeholders and decision makers. Education & Experience Required: • Bachelor's degree in Business, Statistics, Economics or Health Care Administration or reputed company field or equivalent work experience • 5+ years of experience managing healthcare data analysis such as analysis of reputed company claims data and impact to network • Working knowledge of ICD-10 and CPT codes Preferred • Experience with the military health services system, health plans and network providers • Experience with analysis of healthcare claims Key Responsibilities • Maintains a data reputed company of the KSAs and their reputed company weighting by the MTFs reputed company the assigned area of responsibility. Monitors the web-based system which Government Market/MTF Directors access to ensure that any updates made by them are captured for timely analysis, and informed recommendations. . • Working reputed company the TriWest medical management system and other applicable analytical applications, maintains a daily record of the referrals for TRICARE Prime beneficiaries enrolled to the network and highlights those referrals that would be useful for the MTF staff to reputed company their highest value KSAs. • Works in collaboration with committees and adhoc teams from the Data Management, Medical Management, and Provider Services departments, along with the Regional VPs and Directors to identify opportunities to improve the level to which MTFs reputed company their military KSA/readiness goals. • Supports the Regional VPs and Directors in developing information for their monthly meetings with the Market/MTF Directors and staff regarding the extent to which the contracted provider network is meeting their needs and to identify any upcoming changes that may require adjustments to the network. If changes are required, the incumbent will work with them to update their KSA data in the TriWest MTF Optimization Toolset’s Capability and reputed company table. • Attends meetings with MTFs in support of the Regional VPs and Directors (either in-person or virtually) as requested. • Participates in and supports periodic special projects and work groups in the analysis of MTF KSA tables and development of potential business opportunities that may enhance the MTF staff capabilities and achievement of desired clinical skills. • Provides direct support and assistance to the Regional VPs and Directors, and the Provider Services department in business plan development and updates. • Performs 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 reputed company 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 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 reputed company information easily, communicate clearly, and draw sound conclusions. Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements reputed company a high volume, high stress environment. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, reputed company 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 TRICARE, Managed Care, and Health Care Administration, Knowledge of relational databases and SQL server database administration; proficient with MS reputed company Business systems analysis and project management. Working Conditions Working Conditions • Availability to work non-regular hours, including weekend events • Works reputed company a standard office environment, with moderate travel • reputed company reputed company clearance required Company Overview Taking Care of Our Nation’s reputed company. It’s Who We Are. It’s reputed company Do. Do you have a passion for serving those who served? Join the reputed company Team! We’re On a Mission to Serve®! Our job is to reputed company sure that America’s reputed company get connected to health care in the community. At reputed company, 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 reputed company in rewarding loyal, hard-working people who are willing to learn as they grow. reputed company values teamwork. Join reputed company, 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 reputed company salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $95,000 - $122,000 depending on experience* Equal Employment Opportunity reputed company 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 reputed company backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Apply Job!