Job Description

Description

Responsibilities

Conducts TRICARE field operations for Health System Area(s) (HSAs) and where applicable manages their assigned PSA(s). Ensures contractual compliance, maintains MTF relationships and ensures optimal network management and provider relations. The consultant coordinates and directs the efforts of the managed care support office to optimize healthcare delivery and outcomes, and acts as the primary point of contact with Military Treatment Facilities, Commanders and their staffs within assigned HSA and PSA, as applicable. Ensures all relationships provide a foundation of outstanding customer experiences. Manages, implements and ensures activities that enable optimal TRICARE performance guarantees and metrics. Promotes associate engagement.

Key Accountabilities -

* Overseeing TRICARE operations for assigned geographic areas called Health System Areas (HSAs)

* Serving as the contractors initial point of contact and subject matter expert for MTF Commanders and staff regarding contractor activities and interpretation of TRICARE policy and benefits

* Assisting the MTF with urgent TRICARE needs on a day-to-day basis and providing timely resolution and follow-up of beneficiary inquiries referred by BCACs, HBAs, DCAOs, and other MTF personnel

* Coordinating and conducting briefings, education and training, and other customer support activities in assisting the MTF with complex referral/authorization and/or claims issues, such as locating specialized providers and other specialized services (i.e. specialized DME, home infusion services, specialty pharmacy)

* Maintaining/updating ROFR tables as instructed by the MTF and monitoring the capability list for ROFR usage

* Facilitating resolution of enrollment issues and utilization of HEARD Coordinating MTF requests related to the collection, collation, and analysis of enrollment, utilization, claims, and network data

* Overseeing the network in a designated Prime Service Area (PSA) and/or Non-Prime Service Area (NPSA)

Required Qualifications

* Our Department of Defense contract requires U.S. Citizenship

* Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing)

* Previous managed care or TRICARE experience

* Experience coordinating the activities of diverse functions

* Working knowledge of a PC office suite including presentation and spreadsheet software

* Excellent communication skills, both oral and written

* Experience implementing and measuring success on complex health-related initiatives and pilots

* Strategic thinker with ability to work independently

* Strong relationship building skills

* Strong analytical skills

* Process-focused, with ability to leverage and enhance existing processes

Preferred Qualifications

* Bachelor's degree

* Supervisory experience

Scheduled Weekly Hours

40