Manager, Clinical Performance

Profile

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 Department of Defense 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 Summary
Responsible for leading and managing a team of clinical and non-clinical staff in providing project management and logistical and administrative support across the TriWest Clinical Operations areas. Under direction from the Director of Clinical Performance Management, the Manager develops and implements program components to optimize execution of clinical operations, supports strategies and goals to drive improvement, and develops policies and procedures to ensure compliance with contract standards.

Education & Experience
Required:

• Bachelor's degree in a health-related field or business/healthcare administration
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• Minimum of three years of experience demonstrating progressively increased responsibility and management experience in medical or clinical system management
• Must have project management and program development experience and proficient in MS Office and Power BI
• Must have at least three years of supervisory experience
• Demonstrates achievement of performance goals through effective leadership, data analysis, and continuous improvement and monitoring key metrics

Preferred

• Master of Business or Healthcare Administration
• Medical Claims, Utilization Management, Case Management or Medical Clinic management experience
• Formal Project Management, Lean Six Sigma, or other structured project management and execution credentials/experience
• Project Management Professional or other Nationally recognized Project Management credential

Key Responsibilities

• Supports the Director of Clinical Performance to drive compliance, performance, efficiency and effectiveness across all clinical operations functions.
• Leads the team and works collaboratively with other teams to produce performance dashboards and other tools to provide early indicators of risks and issues.
• Direct operational leadership of clinical operations Project Management and clinical support functions and staff to ensure compliance with contract requirements and adherence to contract deliverables while developing and implementing programs and processes to support TriWest Clinical Operations.
• Ensures decisions and actions are data-driven, aligned with organizational objectives, and measurable through established performance indicators.
• Monitors day-to-day operations of the Project Management team to ensure projects are developed and executed IAW TW ePMO standards and identify barriers to timely completion of all approved projects.
• Manage activities necessary to ensure appropriate utilization of resources while maintaining optimal achievable efficiency in supported clinical areas.
• Participates in the development of measurable outcomes, ensures measures are in place to monitor the impact of programs and services on the efficiency and effectiveness of clinical areas supported.
• Systematically evaluates the quality and effectiveness of staff performance, analyzing appropriate data and information to identify areas of improvement; advises and coaches when appropriate and completes annual performance appraisals.
• Plans and implements orientation and training of new-hire employees.
• Ensure adherence to accreditation standards, contract policy, contractual requirements, and nationally recognized practice standards.
• Participates in development of desk procedures, education and auditing to support uniform application of programs and compliance with program policy and standards.
• Participates in interdepartmental committees and/or workgroups that are pertinent to areas of responsibility.
• Performs other duties as assigned.

Competencies
Communication / People Skills:
Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.

Computer Literacy:
Ability to function in a multi-system Microsoft environment using Office products, Outlook, Teams, TriWest Intranet, the Internet, and department software applications. Thorough knowledge and capability with MS Excel use.

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:
Thorough knowledge of health care delivery, UM, CM, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of performance data to identify issues and develop effective improvement strategies.

Team-Building / Team Player:
Influence the actions and opinions of others in a positive direction and build group commitment.

Technical Skills:
Knowledge of healthcare policies and procedures, Managed Care concepts and principles, medical management systems, healthcare operations, and protected health information; working knowledge of Project Management principles and techniques and Lean management principles.

Working Conditions
Working Conditions

• Availability to cover any work shift
• Remote work environment, with minimal travel required
• Extensive computer and telephone work with long periods of sitting

Company 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.

Benefits
We'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
• 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

TriWest job postings typically include a salary range,
which can vary based on the specific role and location
, but generally this position ranges from around $126,000 - $140,000 per year.

Equal Employment Opportunity

TriWest 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 supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and 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.