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 directly to the Director, Provider Data & Systems, this position is responsible for oversight of the quality, data ingestion, training and documentation processes that support the operations and accuracy of the Provider Directory. Represents Provider Services in related process redesign, quality projects as well as cross-functional groups. Executes projects from start to finish. Initiates joint problem-solving using data analysis tools, performance measurements, and decision-making processes. Assists with staff training and developing staff to attain service-level requirements and data accuracy of the TriWest Provider Directories and Contract accuracy. Ensures compliance with TriWest policies and procedures. Oversees implementation of opportunities for improvement regarding regulatory/accreditation compliance.

Education & Experience

Required:

• Bachelor's degree in Business, Communications, or related field or equivalent work experience
• 3+ years Provider data management experience
• 3+ years supervisory experience
• Experience in training, planning, leading, and participating in major process improvement projects
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation

Preferred:

• Experience with Sales Force Cloud or other Data Management systems
• Experience in management/supervision of staff in a managed care environment
• Knowledge of government programs administered by TriWest

Key Responsibilities

• Manages the accuracy and provider data discrepancies related to downstream systems and outbound validations.
• Works with upstream sources as needed to ensure root cause issues are identified and resolved.
• Works closely with analyst, director and other stakeholders to ensure that the provider directory accuracy team meets its goals.
• Ensures compliance with contract requirements and reporting of service levels within Provider Services.
• Designs and manages quality assurance and training programs to improve operational performance.
• Develop, implement and maintain ongoing metrics and monitoring processes to assess effectiveness and efficiency for continuous improvement. Identifies staff development needs and recommends training plans.
• Interviews, selects, onboards, trains and manages staff.
• Contributes to program governance, project reviews, cross-functional communications and training.
• Collaborates with TriWest management team to identify service issues and develop enhanced metrics.
• Contributes to quality projects.
• Evaluates case reviews to identify and address quality and service improvement opportunities.
• Manages the preparation of documentation of reviews for accreditation and regulatory agencies.

• Oversees the quality control activities regarding provider contract and data records that have been entered and processed by staff.
• Partners cross-functionally to promote high-quality service levels throughout TriWest.
• Develops and manages effective training to drive continual quality improvement to cultivate a high-performance workforce.
• Manages daily operational resources, tracking results against requirements.
• Oversees department staff, assigning and monitoring workflow.
• Delivers on-the job training and remedial coaching.
• Participates in special projects and meetings.
• 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; adapts to different styles; listens critically; collaborates.

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.

Leadership: Successfully manages different styles of employees; provides clear direction and effective coaching.

Multi-Tasking / Time Management: Prioritizes and manages 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.

Team-Building / Team Player: Influences the actions and opinions of others in a positive direction and builds group commitment.

Technical Skills: Knowledge of TriWest administered programs, quality assurance programs, instructional design, needs analysis, and post-implementation measurements, quality tools and models; experience with data management, statistical analysis, performance measurement and monitoring, report design, presentation, and meeting facilitation; experience with database software, Excel, Project, PowerPoint, Access, Visio, and other statistical tools.

Working Conditions

Working Conditions:

• Works within a standard office environment, travel may be required
• Extensive computer work with long periods of sitting

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 $97,000 to $107,000 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.