Near Patient Private Sector Care Coordinator

Essential Job Duties and Responsibilities:

A. Overall Purpose Of The Job (Brief description of the primary purpose of this position)

The Near Patient Private Sector Care Coordinator is critical in processing and for the flow of medical information between Private Sector Care Providers and Military Medical Providers within their respective AOR. Additionally, they are expected to provide the high-quality healthcare assistance and, personalized customer service each time they contact TRICARE Overseas Program stakeholders and maintain high standards of professionalism, compassion and, attention to case management detail.

They are a Military Treatment Facility (MTF) embedded asset that handles caseloads for host nation medical care. 
•    Serve as a key administrative support role embedded within Military Treatment Facilities (MTFs) and/or Private Sector healthcare providers.
•    Facilitate coordination between medical teams and private sector care providers to ensure efficient case management.
•    Support clinical operations by managing medical caseloads for beneficiaries receiving private sector care.
•    Arrange, Cancel and Reschedule private sector care appointments as requested. 
•    Additionally, play a critical role in sourcing Medical Records including when required for clinical quality case reviews. 
•    Serve as an escalation point for military medical provider concerns or updates regarding host nation care.

B. Key Responsibilities (Critical responsibilities and skills of this position, listed in order of importance)

Personal Qualities:
•    Handle cases and phone calls efficiently and per the TRICARE Overseas Program Standard Operations Procedures.
•    Works effectively at pace and under pressure. 
•    Assist with the induction of new Coordinators by mentoring them during their training program.
•    Able to provide empathetic, quality service to our customers. 
•    Understands and thrives within a team to deliver effective completion of daily tasks. 
•    Maintains a professional behaviour

Facilitation of Care Coordination:
•    Ensure timely daily case openings to enable the medical team to address patient needs within established Key Performance Indicators (KPIs). 
•    Coordinate the allocation of cases to the appropriate region or department based on clinical requirements. 
•    Communicate evolving demands and caseload changes to relevant stakeholders to support operational responsiveness.
•    Answer all incoming calls using the prescribed protocols transferring all medical calls to the Regional Medical Director and/or TOP Latin America Canada Coordinating Nurse on duty.
•    Ensure providers are selected from the clinical quality optimized TOP Provider Network.
•    Contact the selected provider and arrange the most suitable appointment date and time.
•    Communicate/Coordinate and verify with the military providers and or directly with beneficiaries the appointment details
•    Maintain open communication lines with Other HNCCs, Near Patient Team Members, Regional Call Centers, Provider Network Managers, Client Relationship Leads, Clients and other International SOS Assistance Centre staff when dealing with case management. 
•    Coordinate the retrieval of medical records with Private Sector Care Providers and process the medical records in accordance with Medical Records Collection SOPs 
•    Follow-up with beneficiaries, military providers and private sector care providers by phone or email whenever necessary to ensure optimal information flow to beneficiaries and providers. 
•    Use the CRM Software Management application for all case management, in/out-bound tasks and actions per operating procedures.
•    Maintain the transmission document in a clear, accurate and concise format with the correct plan of action for handovers ensuring the Medical Team are aware of medical records and actions.

Quality Assurance
•    Comply within established service recovery protocol and complete the online CFS form to create feedback records for quality tracking.  
•    Report any cases which may result in a possible complaint to the TLAC Operations Manager
•    Escalate any complaints received to the TLAC Operations Manager and are entered into RiskMan™    
•    In-country support to the clinical quality assurance team with medical record collections for PQI investigations.
•    Maintains confidentiality of all beneficiary information in accordance with HIPAA and GDPR.  carrying out all policies and procedures pertaining to the duties of a TRICARE Customer Service Executive. 
•    Attends and participates in International SOS staff meetings and educational offerings and completes other tasks as directed.

C. Job Profile 

Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)
•    Customer service experience
•    Team player 
•    Identifies and acts on potential problems and /or difficulties 
•    Demonstrates effective problem-solving skills and lateral thinking 
•    Takes initiative, demonstrates responsibility
•    Ability to work under pressure, multi-task and prioritize in a timely and effective manner
•    Ability to provide clear and concise written updates in English
•    Ability to write, speak and listen effectively in English and Spanish

Desired Work Experience (Brief description of the job-related experience needed to perform the job)
•    Customer Service within a matrix organisation
•    Travel or Study Abroad Experience (Studies, Personal, Volunteer) preferred
•    Previous Professional Work Experience after or during College: Financial, Translation, Education, Non-Governmental Organisations 
•    Previous administrative experience in a healthcare setting (doctor’s office, hospital, lab, etc.).
•    Hospitality industry experience desired

Required Qualifications (Brief description of the educational background needed to perform the job)
•    Commensurate Security Clearance based on DoD requirements
•    College Graduate Preferred
•    Preferred Degree in: International Business, Language, Liberal Arts, Business Management
•    Proficient in Web Browsing and Microsoft Office (Outlook and Word)

Required Languages (Brief description of the language skills needed to perform the job)
•    Fluent English
•    Fluent Spanish
•    Other languages an advantage

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)
•    Occasional domestic and/or international travel may be required
•    U.S. drivers’ licence and access to motor vehicle
•    Regular travel to MTF office, as per local policies