Case Manager Nurse Salary in Phoenix, AZ

Job Summary We offer remote work opportunities (AK, AR, AZ, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE,NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, WI & WY only) This leader will report to the Manager of Case Management Special Programs under the overall Case Management program, specifically supporting TRICARE beneficiaries seeking benefits under Extended Care Health Option (ECHO) and Autism Care Demonstration (ACD). Supervises daily operations of case management special programs services and staff. **Veterans, Reservists, Guardsmen, and military family members are encouraged to apply** Education & ExperienceRequired: • Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), with a current unrestricted license, with one (1) year supervisory experience or equivalent leadership role • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation, and o Three years full-time equivalent of direct clinical care to the consumer, and, o Two Years care coordination or case management experience. Preferred: • Experience in TRICARE ECHO and Autism Care Demonstration programs. • Bachelor's degree or higher in health-related field • Case Manager Certification by a URAC-recognized entity (e.g. ANCC, CCMC). If not currently certified, certification will be required within two (2) years of hire. Key Responsibilities• Supervises the daily operations of case management specialty program services. Hires, coaches, counsels, evaluates, and develops clinical and non-clinical staff. Supports recruitment efforts by interviewing, selecting, and training new staff. • Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice. • Coordinates staff orientation and training. Ensures staff provides services within any associated scope of practice and in compliance with organizational protocols, desk procedures, and policies. Provides staff training, including training aids. Documents and assesses effectiveness of staff training. • Supervises individual staff caseload and beneficiary needs to ensure timely delivery of care as well as productivity and timeliness requirements. • Evaluates clinical and non-clinical performance for quality, timeliness, and process consistency. Conducts regular and ad hoc case review audits, providing staff feedback regarding results and process improvement. Participates in the evaluation of the case management program. • Ensures compliance with TriWest policy and Health Care Services desk procedures.• Collaborates with medical providers, the Director, Case Management and the Medical Director for Case Management on program interpretation and guidance. • Participates in clinical and non-clinical performance improvement projects. Actively participates in meetings. • Monitors and provides input on the performance of non-clinical staff. • Supports department by covering case management and care coordination or carrying a case load as necessary. • Performs other duties as assigned. • Regular and reliable attendance is required CompetenciesCoaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback Communication / People Skills: Ability to influence or persuade others under positive or challenging circumstances; adapt to different styles; listen critically; collaborate Computer Literacy: Ability to function in a multi-system Microsoft 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. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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, tactics, and strategies. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of TRICARE policies and procedures; Case Management, ECHO, Autism Care Demonstration, Referral Management, and Utilization Management principles; HIPAA Privacy and Security regulations; URAC accreditation standards, Managed Care concepts; community resources; alternative funding programs; medical management systems. Proficiency with International Classification of Diseases (ICD), Current Procedural Terminology (CPT), Healthcare Common Procedural Coding System (HCPCS). Working ConditionsWorking Conditions: • Availability to cover any work shift • Standard office environment or telecommuting options, minimal travel anticipated. • Extensive computer work with prolonged sittingCompany 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.BenefitsWe'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 OpportunityTriWest 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.

Job Summary We offer remote work opportunities (AK, AR, AZ, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE,NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, WI & WY only) Supervises daily operations of case management services and staff. Hires, trains, coaches, counsels, and develops staff. Monitors individual staff caseloads and beneficiary service levels to ensure delivery of quality and timely Case Management services. Ensures staff is fully informed of changes impacting their work by communicating updates, policy revisions, performance outcomes, and significant events. Advises non-clinical staff regarding Case Management support tasks. Supervisors are responsible for reviewing and understanding the scope of practice of their state of licensure as well as those of associated staff. **Veterans, Reservists, Guardsmen, and military family members are encouraged to apply**Education & ExperienceRequired: • Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW), with a current unrestricted license • Case Manager Certification by a URAC-recognized entity • Three years full-time equivalent of direct clinical care to the consumer • Two Years Case Management or equivalent experience • One year supervisory experience or equivalent leadership role Preferred: • Bachelor's degree or higher in health-related field • Experience in Managed Care or TRICARE healthcare delivery system Key Responsibilities• Supervises the daily operations of case management services. Hires, trains, coaches, counsels, and develops clinical and non-clinical staff. Supports recruitment efforts by interviewing, selecting, and training new staff. • Applies knowledge of HIPAA privacy and security regulations as well as URAC accreditation standards to ensure compliance in daily practice. • Coordinates staff orientation and training. Ensures staff provides case management within scope of practice and in compliance with organizational protocols, desk procedures, and policies. Provides staff training, including training aids. Documents and assesses effectiveness of staff training. • Supervises individual staff caseload and beneficiary treatment plans to ensure delivery of care, productivity, and timeliness. Evaluates case manager practice for quality, timeliness, and process consistency. Conducts regular and ad hoc case review audits, providing staff feedback regarding results and process improvement. Participates in the evaluation of the case management program. • Ensures compliance with TriWest policy and Health Care Services desk procedures. • Collaborates with case managers, care coordinators, medical providers, the Director, Case Management and the Medical Director for Case Management on program interpretation and guidance.• Participates in clinical and non-clinical performance improvement projects. Actively participates in teleconferences and meetings. • Monitors and provides input on the performance of non-clinical staff. • Supports department by carrying a case load as necessary. • Performs other duties as assigned. • Regular and reliable attendance is required. CompetenciesCoaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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 Microsoft 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. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. 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, tactics, and strategies. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of TRICARE policies and procedures, Case Management, Utilization Management, HIPAA Privacy and Security regulations, URAC accreditation standards, Managed Care concepts, Behavioral Health practices and principles, community resources, alternative funding programs, medical management systems. Proficiency with International Classification of Diseases, Current Procedural Terminology, Healthcare Common Procedural Coding System. Working ConditionsWorking Conditions: • Availability to cover any work shift • Works within a standard office environment, with minimal travel • Extensive computer work with prolonged sitting • Department of Defense security clearance requiredCompany 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.BenefitsWe'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 OpportunityTriWest 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.

Join our team as a Unit Manager at Ridgecrest Post Acute!Salary is DOQ/E: $85,000 - 120,000! Communicate regularly with residents and their family about Plans of Care, PT, OT and other treatment protocols. • Attends and participates in morning meetings/stand up to facilitate communications with the team. • Answer residents' questions about their care, treatment plans, illness progression and all other issues so they feel safe and secure in our care. • Monitor and adjust resident's statuses based on changing needs and conditions. • Organize and prioritize daily work by assessing new, current and discharging residents needs in area(s) of responsibility. • Complete documentation as required. • Performs utilization review activities to provide resident appropriate, timely and cost-effective care. • Coordinate care with resident, care providers, facilities financial services, and third-party payers. • Oversee all admissions and discharge activities. • Coordinate referrals both to and from our facility. • Ability to relate positively, effectively, and appropriately with residents, families, staff and professional colleagues. • Accurate charting and ability to complete necessary paperwork in a timely manner. • Ability to work independently and exercise sound judgement in interactions with physicians, providers, payers and residents and their families. • Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including residents/families/caretakers, physicians, nurse and other ancillary partners. • Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities. • Intermediate computer skills. • Competence maintaining professional, respectful, honest interactions with residents/families and staff and partners. Supervisory Requirements This position has no supervisory responsibilities. Qualification Education and/or Experience Bachelor's Degree in Nursing or Social Work. Registered Nurse (RN) license preferred. Licensed (LVN or LPN) nurse acceptable. Two (2) year clinical nursing experience preferred. Knowledge of Medicare, Medi-cal and Medicaid programs and benefits. PCC Knowledge Language Skills Ability to read technical procedures. Ability to read and comprehend policy and procedure manuals. Ability to effectively present information and respond to questions from managers and employees. Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations. Reasoning Ability Ability to solve practical problems. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Certificates, Licenses, Registrations LVN/LPN Valid License or RN Valid Licensee in the state you are working. Certificate as a certified Case Manager (CCM) a plus. Must maintain all required continuing education/licensing. Must remain in good standing with the Department of Public Health; License and Certification Division at all times. Physical Demands The essential functions of this position require the following physical abilities: Standing and /or walking very frequently. Sitting occasionally. Reaching with hands and arms frequently, pushing/pulling very frequently. Talking and /or hearing very frequently. Tasting and /or smelling very frequently. Lifting up to 50 pounds frequently. Climbing, balancing, stooping, kneeling, crouching or crawling occasionally. Close, distance, color, peripheral, and depth perception in vision: ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually low to moderate. Additional Information Note: Nothing in this job specification restricts management's right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons. The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.

Sleep Management, LLC dba ViemedSleep Sales RepresentativeJob Category: Viemed Clinical ServicesRequisition Number: SLEEP001984Full-TimeEssential Sales Duties and Responsibilities:Market VieMed’s OSA and Sleep program to potential and existing referral sourcesDevelop sales territory action plans and call strategies to maintain ongoing business with current accounts and apply working knowledge of clinical, consultative, and strategic selling skills to drive new market potential to grow the business within assigned territoryCoordinate and provide educational presentations and in-services for healthcare providersResponsible for account activity, sales documentation, reports, and territory managementPartners with all clinical, managerial, sales staff, and other internal departments within to promote and market our P services to all referral sources to drive sales growth Required to provide availability for patient contact and response to patient needsMaintain a level of performance that meets or exceeds the sales quotasOther duties/projects as assignedCompetencies:Demonstrated ability to build and maintain solid working relationships with internal and external referral sources geographically located within assigned territoryExhibits effective oral and written communication with physicians, location staff, patients, and all referral sources to ensure questions and concerns are processed promptlyAbility to plan, implement, and execute strategies independently to achieve sales goals effectivelyExhibit a sense of urgency for goal achievement with a strong commitment to resultsBuilds relationships with referral sources, patients, and caregiversStrong organizational, prioritizing, and territory management skillsBe flexible, self-driven, accountable for results, autonomous, yet supportive of team effortsRequirements:The qualified candidate:Must be a resourceful problem solver who thrives in a fast-paced environment.Must be well-connected and have established relationships with the Sleep Specialists within the territory (required)Must be able to provide three informal letters of recommendation from a physician/provider (required)Must have a current, valid, active state driver’s license with a clean driving record and own reliable transportation is required Sales Experience:A proven track record of successful sales experience in a health care setting, and experience working with physicians, and nurses.Two or more years demonstrated full life medical sales experience from lead generation, educating the referral source, persistent follow-up, and follow through on all leads, issues, and success stories7Formal sales training preferred Work Environment:Sales: This job operates in the field by calling on, marketing to both existing and potential referral sources: i.e., Pulmonologist, Sleep Specialists, Cardiologists, Internal Medicine, Family Practice, and Ear Nose and Throat VieMed Offers:Competitive Base SalaryUncapped CommissionsExcellent Orientation ProgramHealth, Dental, & Vision InsurancePTO401K Retirement PlanMonthly Cell Phone AllowanceMarketing AllowanceLife InsuranceAnd Much More!You will be expected to work during regular business hours, Monday through Friday, 8:00 a.m. – 5:00 p.m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties and responsibilities may change at any time with or without notice. Position Summary: This position is a field-based, business development, hands-on clinical sales position that requires a candidate with the drive and skill to be a patient advocate, and positive representative of VieMed. This position is responsible for identifying & initiating one-on-one dialog with new potential referral sources and maintaining positive relationships with existing referral sources. They will leverage their clinical and sales expertise to design/develop cutting edge sales strategies to drive VieMed’s disease management program and respiratory products to new market potential to grow the business within the assigned territory.Works with the office staff to ensure prompt and accurate billing and documentation of services, including providing adequate information to satisfy third-party payor guidelines for coverage The candidate will spend most of their time (80% or more) in the field: networking, building relationships, and educating referral sources* within the hospital on all the benefits of VieMed’s disease management program will improve the lives of their patients with Chronic Respiratory Failure. Hospital Referral Sources: Pulmonologist, Hospitalist, Critical Care Physicians, Case Managers, and Social Workers. Essential Sales Duties and Responsibilities:Market VieMed’s disease management program to potential and existing referral sourcesDevelop sales territory action plans and call strategies to maintain ongoing business with current accounts and apply working knowledge of clinical, consultative, and strategic selling skills to drive new market potential to grow the business within assigned territoryCoordinate and provide educational presentations and in-services for healthcare providersResponsible for account activity, sales documentation, reports, and territory managementPartners with all clinical, managerial, sales staff, and other internal departments within to promote and market our home respiratory therapy services to all referral sources to drive sales growth Required to provide availability for patient contact and response to patient needsMaintain a level of performance that meets or exceeds the sales quotasOther duties/projects as assignedCompetencies:Demonstrated ability to build and maintain solid working relationships with internal and external referral sources geographically located within assigned territoryExhibits effective oral and written communication with physicians, location staff, patients, and all referral sources to ensure questions and concerns are processed promptlyAbility to plan, implement, and execute strategies independently to achieve sales goals effectivelyExhibit a sense of urgency for goal achievement with a strong commitment to resultsBuilds relationships with referral sources, patients, and caregiversStrong organizational, prioritizing, and territory management skillsBe flexible, self-driven, accountable for results, autonomous, yet supportive of team effortsRequirements:The qualified candidate:Must be a resourceful problem solver who thrives in a fast-paced environment.Must be well-connected and have established relationships with the Pulmonary, Critical Care, & Hospitalist physicians within the territory (required)Must be able to provide three informal letters of recommendation from Pulmonologist (required)Must have a current, valid, active state driver’s license with a clean driving record and own reliable transportation is requiredSales Experience:A proven track record of successful sales experience in a health care setting, and experience working with physicians, nursing management, discharge planners, case managers, and social workersTwo or more years demonstrated full life cycle healthcare sales experience from lead generation, educating the referral source, persistent follow-up, and follow through on all leads, issues, and success storiesTwo or more years of experience as a Clinical Liaison, preferably within the LTACH level of carePrevious marketing and/or LTACH marketing experiencePrevious clinical/clinical liaison experience preferred with demonstrated skills in clinical patient assessmentFormal sales training preferred Preferred Licensure & Education:The preferred applicant would be a Respiratory Therapist or Nurse with Adult Critical Care experience with business development/physician marketing experience or have a proven sales record in the local Home Medical Equipment marketClinical Licensure Preferred (RT, RRT, CRT, RCP, RN, LPN)Work Environment:Sales: This job operates in the field by calling on, marketing to both existing and potential referral sources: i.e., Pulmonologist, Hospitalist, Critical Care Physicians, Hospitals, Case Managers, Social Workers, etc. VieMed Offers:Competitive Base SalaryUncapped CommissionsExcellent Orientation ProgramHealth, Dental, & Vision InsurancePTO401K Retirement PlanMonthly Cell Phone AllowanceMarketing AllowanceLife InsuranceAnd Much More!You will be expected to work during regular business hours, Monday through Friday, 8:00 a.m. – 5:00 p.m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties, or responsibilities required of the employee for this job. Duties and responsibilities may change at any time with or without notice. Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)PI239117965

Job Summary We offer remote work opportunities (AK, AR, AZ, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE,NV, NM, NC, ND, OK, OR, SC, SD, TX, UT, VA/DC, WI & WY only) Supervises daily Utilization Management (UM) program operations. This position reports to a Manager of Utilization Management in either Prospective, Retrospective, or Appeals and Reconsideration for the TRICARE contract. The supervisor coordinates across teams to support meeting contractual metrics and timeliness, standardized clinical care requirements and accreditation standards. This position is responsible for supervision of UM performance and staff management. Development and preparation of operational reports. Functions as backup for staff during high volume periods. **Veterans, Reservists, Guardsmen, and military family members are encouraged to apply** Education & ExperienceRequired: • Registered Nurse, with current valid, unrestricted nursing license • 3+ years of job related experience in a healthcare environment • 3+ years supervisory or leadership experience in a healthcare environment • 2+ years utilization review or case management • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Preferred: • Medical/Surgical or Behavioral Health experience • Commercial Managed Care experience • Knowledge of government health care programs • Familiarity with utilization review criteria • CCM or HCQM certification • Knowledge of medical billing and coding • Prior experience with remote work environments Key Responsibilities• Supervises day to day UM operations to ensure operational effectiveness and efficiency. • Ensures staff is fully-informed of changes by communicating updates, policy revisions, performance outcomes, and significant events. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system. • Monitors staff to ensure adherence to established criteria, including InterQyal, internally developed guidelines, decision support tools, contract requirements and TriWest policies and desk procedures. • Prepares reports for tracking and trending of UM activities. • Interprets reports and identifies UM opportunities to share with management. • Monitors the UM process and identifies and implements process improvements to ensure program quality assurance and compliance. • Reports Potential Quality Issues (PQI). • Responsible for interviewing and hiring new staff. • Provides coaching and oversight to staff to ensure staff success and development. • Assists with implementation, orientation and training of new staff.• Assists with the development of desk procedures, processes, workflow changes, and reports. • Systematically evaluates the quality and effectiveness of staff performance. • Advises and coaches when appropriate and completes annual performance appraisals. • Participates in meetings as required. • Collaborates across the clinical operations team for enhancing service levels. • Coordinates activities with contracted partners to meet Utilization Management (UM) Plan goals. • Completes special projects. • Regular and reliable attendance. • Performs other duties as assigned. CompetenciesCoaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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 Microsoft 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. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion 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. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment. 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: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques. Working ConditionsWorking Conditions: • Works non-regular hours, as required • Works remotely, with up to 10% travel • Ability to meet mandatory contract compliance timelines • Extensive computer work with prolonged sittingCompany 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.BenefitsWe'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 OpportunityTriWest 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.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!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, TX, UT, VA/DC, *WA, WI & WY only) Job Summary Supervises daily Utilization Management (UM) program operations. This position reports to a Manager of Utilization Management in either Prospective, Retrospective, or Appeals and Reconsideration for the TRICARE contract. The supervisor coordinates across teams to support meeting contractual metrics and timeliness, standardized clinical care requirements and accreditation standards. This position is responsible for supervision of UM performance and staff management. Development and preparation of operational reports. Functions as backup for staff during high volume periods.Education & Experience Required: • Registered Nurse, with current valid, unrestricted nursing license • 3+ years of job related experience in a healthcare environment • 3+ years supervisory or leadership experience in a healthcare environment • 2+ years utilization review or case management • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Preferred: • Medical/Surgical or Behavioral Health experience • Commercial Managed Care experience • Knowledge of government health care programs • Familiarity with utilization review criteria • CCM or HCQM certification • Knowledge of medical billing and coding • Prior experience with remote work environmentsKey Responsibilities • Supervises day to day UM operations to ensure operational effectiveness and efficiency. • Ensures staff is fully-informed of changes by communicating updates, policy revisions, performance outcomes, and significant events. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system. • Monitors staff to ensure adherence to established criteria, including InterQyal, internally developed guidelines, decision support tools, contract requirements and TriWest policies and desk procedures. • Prepares reports for tracking and trending of UM activities. • Interprets reports and identifies UM opportunities to share with management. • Monitors the UM process and identifies and implements process improvements to ensure program quality assurance and compliance. • Reports Potential Quality Issues (PQI). • Responsible for interviewing and hiring new staff. • Provides coaching and oversight to staff to ensure staff success and development. • Assists with implementation, orientation and training of new staff.• Assists with the development of desk procedures, processes, workflow changes, and reports. • Systematically evaluates the quality and effectiveness of staff performance. • Advises and coaches when appropriate and completes annual performance appraisals. • Participates in meetings as required. • Collaborates across the clinical operations team for enhancing service levels. • Coordinates activities with contracted partners to meet Utilization Management (UM) Plan goals. • Completes special projects. • Regular and reliable attendance. • Performs other duties as assigned.Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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 Microsoft 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. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion 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. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment. 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: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques.Working Conditions Working Conditions: • Works non-regular hours, as required • Works remotely, with up to 10% travel • Ability to meet mandatory contract compliance timelines • Extensive computer work with prolonged sittingCompany 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.BenefitsWe'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 *Annual base salary for Colorado and Washington State residents: $95,000 - $106,000 depending on experience*Equal Employment OpportunityTriWest 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.

Veterans, Reservists, Guardsmen and military family members are encouraged to apply!!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, TX, UT, VA/DC, *WA, WI & WY only) Job Summary Supervises daily Utilization Management (UM) program operations. This position reports to a Manager of Utilization Management in either Prospective, Retrospective, or Appeals and Reconsideration for the TRICARE contract. The supervisor coordinates across teams to support meeting contractual metrics and timeliness, standardized clinical care requirements and accreditation standards. This position is responsible for supervision of UM performance and staff management. Development and preparation of operational reports. Functions as backup for staff during high volume periods.Education & Experience Required: • Registered Nurse, with current valid, unrestricted nursing license • 3+ years of job related experience in a healthcare environment • 3+ years supervisory or leadership experience in a healthcare environment • 2+ years utilization review or case management • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation Preferred: • Medical/Surgical or Behavioral Health experience • Commercial Managed Care experience • Knowledge of government health care programs • Familiarity with utilization review criteria • CCM or HCQM certification • Knowledge of medical billing and coding • Prior experience with remote work environmentsKey Responsibilities • Supervises day to day UM operations to ensure operational effectiveness and efficiency. • Ensures staff is fully-informed of changes by communicating updates, policy revisions, performance outcomes, and significant events. • Prepares work schedules and monitors staff caseloads to ensure adequate staffing levels at all times and accurate data entry and application of the medical management system. • Monitors staff to ensure adherence to established criteria, including InterQyal, internally developed guidelines, decision support tools, contract requirements and TriWest policies and desk procedures. • Prepares reports for tracking and trending of UM activities. • Interprets reports and identifies UM opportunities to share with management. • Monitors the UM process and identifies and implements process improvements to ensure program quality assurance and compliance. • Reports Potential Quality Issues (PQI). • Responsible for interviewing and hiring new staff. • Provides coaching and oversight to staff to ensure staff success and development. • Assists with implementation, orientation and training of new staff.• Assists with the development of desk procedures, processes, workflow changes, and reports. • Systematically evaluates the quality and effectiveness of staff performance. • Advises and coaches when appropriate and completes annual performance appraisals. • Participates in meetings as required. • Collaborates across the clinical operations team for enhancing service levels. • Coordinates activities with contracted partners to meet Utilization Management (UM) Plan goals. • Completes special projects. • Regular and reliable attendance. • Performs other duties as assigned.Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. 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 Microsoft 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. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion 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. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment. 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: Thorough knowledge of policies and procedures, knowledge of managed care principles and methods; medical terminology; proficiency in the application of clinical criteria: InterQual, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, current Procedural Terminology, and Healthcare Common Procedural Coding System, and American Dental codes; working knowledge with medical management systems; proficient with Microsoft Office; knowledge of UM Process; reporting techniques.Working Conditions Working Conditions: • Works non-regular hours, as required • Works remotely, with up to 10% travel • Ability to meet mandatory contract compliance timelines • Extensive computer work with prolonged sittingCompany 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.BenefitsWe'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 *Annual base salary for Colorado and Washington State residents: $95,000 - $106,000 depending on experience*Equal Employment OpportunityTriWest 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.

About UsIntegrity Management Services, Inc. (IntegrityM) is an award-winning, women-owned small business specializing in assisting government and commercial clients in compliance and program integrity efforts, including the prevention and detection of fraud, waste and abuse in government programs. Results are achieved through data analytics, technology solutions, audit, investigation, and medical review.At IntegrityM, we offer a culture of opportunity, recognition, collaboration, compassion and supporting our community. We thrive off of these fundamental elements that make IntegrityM a great place to work. Our small, flexible workplace offers an exceptional quality of life and promotes corporate-driven sustainability. We deliver creative solutions that exceed goals and foster a dynamic, idea-driven environment that nurtures our employees' professional development. Large company perks...Small company feel!We are now seeking a Medical Review Manager to join our team. This is a contingent position.RequirementsMinimum three (3) years' experience practicing nursing as a licensed Registered NurseMinimum of three (3) years' experience of supervisory/managerial experience in the health insurance industryBachelor's degree in Nursing is required. Registered Nurse LicensureCertified Professional Coder (CPC) Certification or the ability to obtain this certification or similar coding certification within 12 months of appointment

Description Carelon Health is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. Nurse Practitioner - Virtual 24/7 Carelon Health Nurse Line Location: This position will work a Hybrid Model (remote 4 days a week and 1 day a week in the office). Ideal candidates Must live within 50 miles of an Elevance Health corporate office. Work Shift: 4/10 work shifts, Saturday, Sunday, Monday & Tuesday from 1 pm (EST) to 11 pm (EST). This position will be eligible for a shift differential for nights/weekend. The Nurse Practitioner is responsible for managing patient care and treatment (telephonically and/or video) in collaboration with the physician. Responsible for clinical escalations from the triage RN. The Nurse Practitioner in this position will develop and help orchestrate clinical plan of care for chronic and complex conditions. How will you make an impact: Responsible for reviewing clinical assessments gathered by triage RN and helping develop a plan of care for patient's concern. Provides clinical support to triage RNs as clinical questions or concerns arise. Will assess and treat patients via virtual and/or telephonic visits as medically appropriate. Perform health assessments and preventative health measures within prescribed guidelines. Order, interpret and evaluate diagnostic tests to identify and assess patient's clinical problems and health care needs. Participate in review of clinical cases with physician colleagues and market leaders to ensure ongoing quality care delivery. Formulate and document care plan. Prescribe medication or other forms of treatment. Minimum Requirements: Requires an MS in Nursing and minimum of 1 year of related experience with clinical emphasis for nurse practitioner; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license And NP license in applicable state is required. Possession of DEA registration or eligibility. For Carelon Health, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Skills, Capabilities and Experiences: Virtual care experience. Urgent care experience. Experience working with multiple software programs. Bilingual communication skills. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] assistance.