TRICARE Nurse
Trevose, PA, US
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ARE YOU PASSIONATE ABOUT NURSING AND LOOKING FOR A CHANGE? WOULD YOU LIKE TO PROVIDE HIGH-QUALITY, PATIENT–FIRST CARE WORLDWIDE FROM A CORPORATE OFFICE, WITHOUT THE DEMANDS OF THE CLINICAL ENVIRONMENT AND NIGHT SHIFTS?
Join International SOS Government Services and support our U.S. Military Service Members and other eligible beneficiaries by collaborating with a multidisciplinary team to facilitate SEAMLESS COMMUNICATION AND CONTINUITY OF CARE!
ROLE SPECIFICS
- An office-based contact center position in Trevose, Pa.
- Start: July 8, 2024
- Schedule: 4-10 hr shifts or 5-8 hr shifts a week/1 weekend a month/3 holidays per year
- Accepting any US State or US Territory RN licensure
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 Coordinating 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 regional contact centres.
Key Responsibilities
• Ensure a high level of professionalism at all times when dealing with beneficiaries, colleagues, and TRICARE.
• Telephone 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 and determine the frequency/intensity of medical contacts and communication with medical professionals and, beneficiaries
• Communicate with healthcare providers and medical professionals in the region to assess international standards of care being provided to beneficiaries.
• Demonstrate proficiency in utilizing the Electronic Health Record and communicating medical information regarding beneficiary’s clinical status to the client in a confidential and time bound manner while delivering appropriate medical management recommendations verbally and/or in writing to the TRICARE Area Office.
• Ensure optimal quality case coordination and service delivery.
• Responsible 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) and appropriately escalating to the Medical Director as indicated.
• 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.
• Ensure that all medical information released upholds all consent and confidentiality rules as per HIPPA requirements.
• 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.
• 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 Regional Contact Centres (TRICARE Philadelphia (TPL), TRICARE London (TLN), TRICARE Singapore (TSN)) as required.
• Other duties as assigned
Job Profile
Required Competencies (Critical behaviours necessary to successfully perform the job)
• Writing & Reporting: Writes clearly, succinctly, and correctly; Writes convincingly in an engaging and expressive manner; Avoids the unnecessary use of jargon or complicated language; Writes in a well-structured and logical way; Structures information to meet the needs and understanding of the intended audience
• Delivering Results & Meeting Customer Expectations: Focuses on customer needs and satisfaction; Sets high standards for quality and quantity; Monitors and maintains quality and productivity; Works in a systematic, methodical, and orderly way; consistently achieves project goals.
• Adapting & Responding to Change: Adapts to changing circumstances accepts; new ideas and changes initiatives; Adapts interpersonal style to suit different people or situations; shows respect and sensitivity towards cultural and religious differences; Deals with ambiguity, making positive use of the opportunities it presents
• Coping with Pressure: Works productively in a pressurised environment; Keeps emotions under control during difficult situations; Balances the demands of a work life and a personal life; Maintains a positive outlook at work; Handles criticism well and learns from it
• Working with People: Demonstrates an interest in and understanding of others; Adapts to the team and builds team spirit; Recognises and rewards the contribution of others; Listens, consults others, and communicates proactively; Supports and cares for others; Develops and openly communicates self-insight.
Required Experience and Requirements
Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)
• Previous experience in clinical case management desirable
• Previous telephone triage experience desirable
• Broad medical knowledge and experience in one or more or of the following areas, and a critical thinking skillset:
- Primary Care / General Medical / Surgical
- Acute care (ICU/ED)
- Cruise ship nursing
• Computer literacy skills
• Excellent customer service skills.
Required Education/Certification (Brief Description of Education required to perform the job)
• Current and unrestricted Nursing license from any US State or US Territory
• Associate’s or Bachelor’s degree in nursing is required from an Accredited nursing program.
Required Qualifications (Brief Description of Qualifications required to perform the job)
• This position does require someone who can obtain a Tier 1 background investigation for a position of trust after being offered a position and maintaining after starting with International SOS. International SOS will facilitate after hire.
Required Languages (Brief description of the language skills needed to perform the job)
• English
Spanish desired (but not required)
Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
• None required
International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.
This job description outlines the types of responsibilities the incumbent is required to perform. The incumbent may be required to perform job related tasks other than those specifically presented in this job description. This job description is subject to regular review.
