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TRICARE Medical Review Nurse Team Lead

Date: Jun 11, 2022

Location: CZ

Company: International SOS

International SOS is the world’s leading medical and security services company with over 12,000 employees working in 1,000 locations in 90 countries. Established 35 years ago, we have become market leader in global telehealth services and digital health solutions for an extensive client base of Fortune 500 companies, NGO’s and governments around the world.

Description:

 

The TOP Medical Review Nurse Team Leader is responsible for leading a team of Medical Review Nurses in Prague serving all three Regional Contact Centers and the Regional Medical Teams. The role has strong interface with the TRICARE Program Administration Team based in Prague and the Medical Management Team in London.

The TOP Medical Review Team Leader is responsible for the monitoring and support of the Medical Review Team in the pursuit of quality, best practice and outcomes for the TRICARE Overseas Program, specifically in the areas of reviewing and processing incoming medical reports, and undertaking benefit reviews for TOP PRIME and TOP PRIME Remote beneficiaries.

Essential Job Duties and Responsibilities:

 

KEY RESPONSIBILITIES


1. Medical Records Reviews: 

Ensure the Medical Review Nurse team review and process medical reports according to SOP in a timely manner:

  • Checking for accuracy and completeness and raising any quality issues identified 
  • Closing cases where no further action is required
  • Distributing tasks to the relevant medical team’s CRM queue if further immediate action is required or contacting the beneficiary to forward the MR and inform them of non-urgent advice for follow up care in the future (e.g. repeat mammogram in 2 years)
  • Undertake responsibility for all medical information released from the Contact Center to ensure consent and confidentiality are maintained.

 

2. Benefits reviews:

  • Manage the allocation of the daily caseload of DTNR and PRIME Remote cases requiring medical input from the Medical Review Nurse team
  • Ensure that the Medical Review Nurse team conducts benefit reviews in an accurate and timely manner with respect to TOP policy and KPIs

 

3. Operational/Day to day:

  • Ensure the Medical Review Nurse team are familiar with all relevant International SOS policies and TRICARE procedures and that they are followed at all times.
  • Ensure through constant monitoring that the Medical Review Nurses are compliant with their job functions.
  • Facilitate effective positive teamwork and strong channels of communication both internally and externally.
  • Apply continuous process improvement principles and practices and analyse workplace data    optimize work centre operations 
  • Prepare the Medical Review Nurse roster in a timely manner and review team members’ government timesheet on a weekly basis.

 

QUALIFICATIONS

 

What We Require:

  • Registered nurse with previous supervisory experience or exposure
  • Experience in utilization or case management preferred but not required 
  • Registered Nurse in country of origin/residence
  • Excellent spoken and written English
  • Good communicator
  • Very high level of customer service commitment 
  • Excellent teamworking and ability to develop cross functional relationships.
  • Ability to promote a high level of trust and integrity within the team and other departments.
  • Excellent problem-solving skills. 

IMPORTANT NOTE: Before applying please make sure that you have a valid work and resident visa for the Czech Republic.

 

What We Offer:

  • Compensation: Competitive salary
  • Benefits/Perks: Annual Leave (paid vacation days + recuperation of working hours), Health benefits... Level up your skills with our very own platform. Initiatives to meet with team members from around the world.
  • Balance: We offer annual leave. 
  • Culture: Be a part of a global team. We are powered through our culture of collaboration (ask us about it)! Make an impact in a high autonomous, low authority and highly dynamic environment.

 

At International SOS, we offer a great working environment, thanks to our commitment to flexible working, diversity, and development.  We encourage every person to be their personal best by creating an environment of inclusion, equality and support.

International SOS has been recognised as a Top Employer in the UK by the Top Employer’s Institute (TEI) for 2021.