Case Manager

TriWest Healthcare Alliance - Phoenix, AZ

Job Title: Case Manager

Position: Case Management services for TRICARE beneficiaries

Job Type: Remote

Pay: $83,000 - $88,000 per year

Shift:

Work Type: Remote

Address:

City: Phoenix

State: AZ

ZIP Code:

Screen referrals for Case Management and perform comprehensive assessments.
Develop and implement individualized Care Plans for beneficiaries.
Monitor effectiveness and desired outcomes of care plans.
Review and perform reassessments as needed for identified needs.
Process authorization and referral requests according to policy.
Ensure compliance with HIPAA privacy and security regulations and URAC accreditation standards.
Identify beneficiaries at high risk for significant adverse health outcomes.
Document case management enrollment and acceptance letters.
Complete comprehensive case management assessments.
Make care plans available to Primary Care Managers or Behavioral Health providers.
Reassess and monitor care plans on a monthly basis to address newly identified needs.
Evaluate case management outcomes and assess beneficiary satisfaction.
Prepare and present cases involving high-profile or sensitive issues to the Medical Director.
Advocate for beneficiaries by ensuring access to necessary care.
Support beneficiaries with TRICARE and community resource information.

Knowledge of Case Management, Utilization Management, TRICARE policies and procedures
Proficiency in Microsoft applications and departmental specific software
Effective communication and people skills
Strong organizational and problem-solving skills

Experience: Two years full-time equivalent of direct clinical care.

Education: Current unrestricted state license as Licensed Clinical Social Worker, Registered Nurse, or Clinical Psychologist.

License & Certification:

Schedule:

COVID-19 Requirements: Not Specified

TriWest Healthcare Alliance is an equal employment opportunity employer.
They promote an inclusive work environment and encourage candidates from all backgrounds to apply.