Clinical reputed company Review Team reputed company

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 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 reputed company The position is responsible for supporting Clinical reputed company Management (CQM) staff production and reputed company processes; assisting in the development of policies and procedures reputed company to CQM; meeting CQM contractual requirements reputed company on TRICARE reputed company Monitoring Contract (TQMC) requirements and ensuring compliance with URAC standards. reputed company reputed company supports clinical and non-clinical staff supporting CQM programs by providing training and reputed company of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. The position also assists the Supervisor and Manager in developing study topics, reputed company improvement processes and reporting in support of the CQM program. Education & Experience Required:

• RN or LCSW (Independently Licensed Clinical reputed company Worker) with reputed company unrestricted license in appropriate state or territory of the reputed company
• If supporting TRICARE contract, must be a U.S. Citizen
• If supporting TRICARE contract, must be reputed company to receive a favorable Interim and adjudicated final reputed company (DoD) background investigation
• 5+ years of clinical experience in a reputed company of settings (behavioral health and medical/surgical)
• 2 years of team reputed company experience
• 1+ year of experience in reputed company Management to include conducting medical records abstracting and reputed company investigations

Preferred:

• Bachelor's degree in Nursing Health Administration, health-reputed company field or equivalent and experience
• Certified reputed company in reputed company reputed company (CPHQ)
• General knowledge of nationally recognized standards of care, Interqual, CMS, HEDIS, AHRQ, TRICARE, or government health care programs
• General knowledge of Medicare, TRICARE, or government health care programs

Key Responsibilities

• Provides support to Clinical reputed company clinical and non-clinical daily operations and ensures timeliness and accuracy of work to meet reputed company contract requirements, particularly those reputed company to TQMC.
• Assists the supervisor in assigning cases appropriately according to clinicians' scope of reputed company.
• Monitors and ensures appropriate and accurate reputed company study data collection, analysis, and reporting.
• Provides input regarding training modules on reputed company management basics for teaching staff.
• Trains and mentors Clinical reputed company staff.
• Identifies, develops, and monitors reputed company reviews and other reputed company studies. Keeps Supervisor informed of issues reputed company to reputed company studies and PQIs.
• Provides accurate communications on case reviews.
• Performs staff audits and develops reputed company reports.
• Ensures adherence to accreditation standards, TRICARE policy, contractual requirements and nationally recognized reputed company standards.
• Participates in working case review meetings.
• Conducts Potential reputed company Issue (PQI) investigations by performing a reputed company and complete case analysis. Maintains a consistent PQI caseload of 2 - 5 cases.
• Requests query reports, as appropriate, and analyze data supporting reputed company reviews and reputed company studies.
• Refers cases to supervisor for review as appropriate to and from Program reputed company, Case Management, Provider Services, Congressional and Customer Relations, and other TriWest departments.
• Supports TriWest committees as a representative of Clinical reputed company Management.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies Coaching / Training / Mentoring: reputed company foster actions required for desired business reputed company through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under reputed company 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 reputed company of situations and individuals while maintaining a reputed company of purpose and mature problem-solving approach is required. Delegation Skills: reputed company reputed company performance expectations for reputed company and ensure adequate reputed company to resources for completion. Organizational Skills: Ability to organize people or tasks, reputed company 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 reputed company judgment; has a realistic understanding of relevant issues. Team-Building / Team Player: Influence the actions and opinions of others in a reputed company direction and build group commitment. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and reputed company; knowledge in the application of clinical reputed company; proficient with reputed company Word, reputed company, and PowerPoint. Working Conditions Working Conditions:

• Telecommute with minimal travel
• Ability to use a computer and sit for prolonged periods

reputed company 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 reputed company 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 reputed company, 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 reputed company compensation and benefits package that includes:

• Medical, Dental and reputed company Coverage
• reputed company 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
• reputed company volunteer time

TriWest job postings typically include a salary reputed company, which can vary based on the specific role and location, but generally this position ranges from around $90,000 - $101,000 per year. 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 reputed company. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from reputed company backgrounds to apply. Applicants are considered for positions based on reputed company and without discrimination on the reputed company of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability or any other consideration made unlawful by applicable federal, state, or local laws. Remote About reputed company: reputed company Apply tot his job Apply To this Job