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TRICARE Nurse

Requisition Number:  31200
Location: 

Trevose, PA, US

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Overall Purpose of the Role

International SOS provides comprehensive healthcare management to beneficiaries enrolled in the TRICARE Overseas Program (TOP).

This role will require close interface and regular communication with TRICARE, our client, and with their beneficiaries who are enrolled in each region. The TRICARE Nurse will be responsible for the delivery of professional and effective medical assistance services for TRICARE beneficiaries in compliance with TRICARE guidelines and TOP Contract specifications and expectations, maintaining International SOS highest standards of excellence within the respective contact centres. 

The TRICARE Nurse will work closely with the TOP Medical team, such as the Near Patient Team (NPT) where applicable, and with the TOP Operations team.  

Key Responsibilities

•    Triage beneficiaries to assess and direct the standards of care they require.
•    Undertake policy reviews for requested healthcare services, issue authorisations and denials.
•    Perform assessments on standards of care tailored to each specific location and medical situation, utilizing all available resources.
•    Provide comprehensive medical advice and recommendations according to each individual medical situation.
•    Medically monitor beneficiaries for the duration of admission to a healthcare provider.
•    Communicate with healthcare providers and medical professionals in the region to assess international standards of care being provided to beneficiaries.
•    Prepare report and verbally communicate medical information regarding beneficiary clinical status to the client in a confidential and time bound manner. 
•    Interact with operations and logistical team coordinators to ensure optimal quality case management and service delivery. 
•    Responsibility for medical due diligence, case direction and medical related tasks with respect to all medical assistance cases across the TRICARE platforms (i.e. incoming calls, inpatients, high priority cases, policy reviews). 
•    Assessment of each case with respect to its medical elements and provide direction in order to facilitate medical due diligence and render the appropriate assistance.
•    Provide medically driven case direction during the daily handovers.
•    Determine the frequency/intensity of medical contacts and communication with medical professionals and, beneficiaries. 
•    Liaise with medical and operational staff to facilitate the efficient management and direction of case work.
•    Receive and assess all medically related calls received from clients and beneficiaries and collect logistical, medical and collateral histories.
•    Provide telephonic medical assessment of beneficiaries in the region, refer to appropriate care and monitor the quality of the treatment being received. 
•    Sourcing medical referrals on the database system so that beneficiaries are referred to appropriate levels of care. 
•    Obtaining updates on beneficiaries being treated or hospitalised in a timely manner. 

Key Responsibilities Continued

•    Promote and reinforce the need for evidence-based medical decision making.
•    Review of the medical treatment received or recommended to beneficiaries to ensure it is medically appropriate, authorise cover and issue authorization under the TRICARE policy.
•    Communicate the progress of a beneficiary’s condition and deliver appropriate medical management recommendations verbally and/or in writing to the TRICARE Area Office.
•    Ensure that all medical information released upholds all consent and confidentiality rules as per HIPPA requirements.
•    Focus on quality of service delivery to ensure that the highest possible levels are achieved. 
•    Manage complaints in a professional manner, resolving them wherever possible or escalating them to the appropriate department or your line manager.
•    Assess the medical and logistical aspects of medical evacuations and repatriation, including, but not limited to, the assessment of the necessity of an evacuation and the means by which it should take place. 
•    Ensure a high level of professionalism at all times when dealing with beneficiaries, colleagues and TRICARE.
•    Support medical management and TRICARE learning and development teams with the training of TRICARE staff as a buddy or mentor.  
•    Provide Global Medical Support for each Assistance Center (TPL, TLN, TSN) as required.

Required Experience and Requirements

Required Work Experience (Brief description of the job-related experience needed to perform the job)
•    Experience in Primary Care
•    Previous experience in the following are desirable, but not essential
•    Case Management 
•    Telephone triage
•    Acute Care

 

Required Qualifications (Brief description of the educational background needed to perform the job)
•    Registered General Nurse Active Registration/License 
•    PHL - USA Nursing licensure 
•    Valid Citizenship, residency or Visa for region applying – To be discussed upon application 
•    BLS certification or able to obtain within 6 months of starting. 

•    Must be a US Citizen and able to obtain interim Tier 3/ Level II IT Security Clearance and maintain full Tier 3/ Level II IT Security Clearance (previously referred to as ADP II Clearance) upon offer acceptance

 

Required Languages (Brief description of the language skills needed to perform the job)
•    Excellent written and oral English Language
•    Spanish language skills desired, but not required (Americas region only) 

 

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
•    None required

 

 

International SOS Government Services, Inc. require all prospective employees to be fully vaccinated against COVID- 19, where allowed by law.