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RN - Referral Management Liaison TRICARE - Bremerton, WA
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Bremerton, WA Bremerton, Washington |
About this job
Position Descriptions:
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 Responsibilities:
- Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers
- Quickly and accurately identify and assess customer issues and resolve the issues real-time
- Identify and resolve operational problems using defined processes, expertise and judgment
- Investigate claim and/or customer service issues as identified and communicate resolution to customers
- Provide feedback to team members regarding improvement opportunities
- Provide expertise and customer service support to members, customers, and/or providers
- Quickly establish rapport relating to the customer in a polite, positive and courteous manner
- Project patience, empathy, caring, and sincerity in voice tone and words
- Express thoughts and information clearly and succinctly
- Handle irate callers in a manner that defuses their emotion
- Achieve quality and efficiency objectives
- Maintain proficiency in all technical applications (technical skills and system knowledge)
- Comply with all current policies, procedures and workflows
- Primary functions are performed at a Military Treatment Facility (MTF), on a military installation. The MTF Referral 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.
- 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
- Current and unrestricted Nursing license in the State of Washington
- Associate's Degree or higher
- Intermediate proficiency in MS Word, Excel, 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
- 2+ years of experience and knowledge of TRICARE and/or the Military Health System
Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That's why UnitedHealthcare is the organization that's called on to serve them and their loved ones. We're all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It's a genuine opportunity to do your life's best work.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
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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