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Referral Management Liaison TRICARE - Honolulu, HI
| Hours | Full-time, Part-time |
|---|---|
| Location | Honolulu, HI Honolulu, Hawaii |
About this job
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM
The purpose of Referral Management Liaison is to delight our customers by resolving their issues through fast and accurate problem identification, routing to the appropriate department or Account Manager when applicable with resolution or status of issues requiring additional research.
Primary functions are performed at a Military Treatment Facility (MTF), on a military installation. The Referral Management Liaison serves as the Referral Liaison for all MTF referral/authorization situations, as well as network/provider support, enrollment/PCM changes, medical and case management, education and claims assistance. Works with the Vice President of Market Operations (VPMO)/Director of Market Operations (DMO) to assist in building and maintaining relationships between MTF staff, civilian providers and facilities; and supports MTF Optimization initiatives.
Primary Responsibilities:
- Acts as primary Referral Liaison for the MTF Referral Management Center. Maintains ongoing communications with the MTF Referral Management Center and/or MTF TRICARE Operations staff to resolve identified referral and authorization issues. Process STAT and Urgent referrals from the MTF.
- Assists various MTF staff with inquiries utilizing UHC M&V tools and processes: status of enrollment, correspondence, billing and payment, processes Urgent referrals, corrects misdirected referrals, etc.
- Participates as a team member with Medical Management regarding Referral Processing, Utilization Management (UM), Case Management (CM), and Integrated Behavioral Health (IBH) initiatives.
- Collaborates with the MTF staff to identify and refer patients for potential CM, DM or other services, as indicated per UHC M&V processes
- Primary contact for MTF with coordinating In and Out Processing
- May supervise a small number of enrollment specialists
- Ensures implementation and compliance with UnitedHealthcare Military & Veterans (UHC M&V) policies, procedures and performance standards.
- Maintains close communications with the VPMO/DMO regarding MTF issues.
- Actively participates in meetings and communications with MTF staff.
- Assists the VPMO/DMO in planning meetings and participates in those meetings.
- Delivers or assists with a variety of prepared local/Military Installation/MTF-level presentations weekly/monthly about the TRICARE Program to small and large groups, including support/conduct of beneficiary education briefings/events and in-processing/out-processing activities, as requested and/or required by Installation/MTF leadership/staff.
- Facilitates special coordination of beneficiary care issues between the MTF, UHC M&V Corporate resources.
- Participates in meetings, projects, and training as directed by the VPMO/DMO.
- Identifies and reports potential risk management and quality of care issues to the VPMO/DMO, Regional CEO and/or medical management staff as appropriate.
- Provides information to the MTF on the availability of local area healthcare resources and programs.
- Provides phone assistance to civilian providers with benefit, referral and claims issues, ROFR process, command approvals, and eligibility questions in partnership with Provider Advocate
- May accompany Provider Relations personnel on provider visits, as requested, to educate them on referral process, claims, as requested by the MTF to maintain local provider relationships
- Performs other duties as assigned
- Regular and reliable attendance is required
- Responsibilities will include acting on behalf of the VPMO/DMO as needed
Requirements
- HS Diploma/GED required
- Current and unrestricted Nursing license in the State of Hawaii (RN or LPN)
- 1+ year of experience and knowledge of TRICARE and/or the Military Health System
- Basic proficiency with MS Word, Excel and Outlook
- United States Citizenship
- Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86.
- Valid driver's license; access to a registered vehicle or ability to travel to various locations throughout the course of the business day
- Candidates must have MTF-required immunizations and TB test where required.
- 5+ years of clinical nursing or related experience is preferred
As a requirement
of UnitedHealth Group's contract with the Department of Defense, this position
requires U.S. citizenship and proof of favorable adjudication following
submission of Department of Defense form SF86 ,
(the National Agency Check or “NACâ€). Successful
completion of the NAC process is a requirement for continued employment in this
role. NAC processing will be initiated
by our TRICARE Security Officer post-offer, and can take 3-6 months for a final
decision communication from the Department of Defense. Candidates will be allowed to begin
employment with UnitedHealth Group in this role based on an interim clearance,
and final results will be communicated as they are received. Failure to obtain final NAC approval will
result in termination from this role.
UnitedHealthcare Military
& Veterans
is part of the family of companies that make UnitedHealth Group one of the
leaders across the US health care system.
We serve those who serve our nation, providing quality health care services to
millions of military beneficiaries across the (list region post award).
Our commitment to helping people live healthier lives, and to continue the
honor, satisfaction, and quality of the TRICARE military health benefit program
is greater than ever. Our efforts complement the Military Health System to
demonstrate the best blend of public and private health care solutions.
It's not just business as usual. It is one of our proudest endeavors.
If you're ready to help make health care work better for those who serve our
nation. If you are smart, creative, and committed. If you want to make a
difference. Consider being part of the elite team at UnitedHealth care Military
& Veterans.
This is an opportunity to share in something special; a chance for all of us to
serve, to excel, and to know that we've made a difference for those families
who have made our nation stronger.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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