Vice President, Referral Management (Finance)

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 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

Under the direction of the Chief, Customer Service Officer, this position is responsible for the strategic vision, oversight and success of the Referral Management Program in support of the T-5 TRICARE West Region contract. As a senior leader within the organization, this individual is responsible for ensuring the highest levels of satisfaction are achieved with Defense Health Agency (DHA) leaders, including the Military Treatment Facility (MTF) Commanders and personnel with vested interests in TriWest's ability to achieve and maintain successful referral operations. This individual is responsible for ensuring TriWest's contractual requirements related to referral management are achieved, to include those requirements with significant financial implications to TriWest. This includes ensuring timely and accurate processing and achieving in-network utilization metrics, as examples. In collaboration with Clinical Operations and the Military and Veterans Services (MVS) teams, the Vice President works in partnership to maintain positive and collaborative senior- level DHA/MTF relationships and serves as an executive sponsor and participant in internal projects and discussions aimed at improving departmental efficiencies and developing visionary solutions to business problems.

Education & Experience

Required:

• Bachelor's Degree in Business Administration, Finance, Health Care Administration or related field or equivalent experience
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 5+ years of executive-level management and leadership experience in health care operations
• Proven experience in managing people, processes and systems to meet operational goals and performance metrics

Preferred:

• Master's Degree in Health Administration, Business or related field • Knowledge of medical management, including referral management and utilization management
• Prior experience leading referral operations at an MTF or TRICARE managed care support contractor

Key Responsibilities

• Provides strategic vision and direction to the referral management operation to ensure the department is fulfilling its contributions towards program-wide success and ensures TriWest's annual operating plan/financial targets are met.
• Leads a team of Directors and other leadership and support staff, interacts frequently with TriWest's Senior Operations Group, to include the Chief Medical Officer (CMO), Chief Financial Officer (CFO) and their respective senior leaders to solve business problems at a strategic level.
• Interacts frequently with those at DHA directly responsible for referrals, to include the referral Subject Matter Expert points of contact, referral leaders within the MTFs, and other DHA leaders as necessary, to coordinate work requests, review MTF capabilities, and collaborate on issues such as Right-of-First-Refusal (ROFR) protocols and medical documentation return challenges.
• Serves as key liaison with Defense Health Agency leadership on solving business problems related to referral processing, to include maximization of MTF capabilities and capacities, gap identification and further development of TriWest's local provider networks as a result of referral challenges, management of directed referrals, and Right-of-First refusal issue resolution.

• Develops a cohesive business strategy with TriWest's Senior Clinical Operations leadership, to include the Chief Medical Officer and Senior Vice President, Clinical Operations, to ensure timely communication and coordination on all clinically based issues.
• Serves as executive sponsor on all technology projects aimed at improving the referral management process. This includes provisioning the infusion of artificial intelligence, natural language processing, and other innovations into the referral management process, to streamline work processes and ensure accurate and timely processing.
• Develops and participates in ongoing strategy discussions aimed at securing future business opportunities where referral management and processing plays a key role in demonstrating TriWest's core competencies. Ensures past performance ratings are maintained at a competitive level throughout the life of the contract. Participates in new business development activities as a subject matter expert on referral management.
• Creates compelling TRICARE Award Fee content in collaboration with TriWest's Contracts team by creating and documenting departmental successes.

Competencies

Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback.

Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

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: Successfully manage different styles of employees; provide clear direction and effective coaching.

Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within 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: Direct experience within a managed care setting and/or TRICARE and the Military Health System (MHS).

Working Conditions

Working Conditions:

• Works non-regular hours, as required
• Works within an office environment, travel required (approximately 35%)
• Extensive computer work with prolonged sitting
• Department of Defense security clearance required

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.

DoD Statement

Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.

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
• 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

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 cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions 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.