TRICARE Senior Coordinating Nurse

Essential Job Duties and Responsibilities:

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

This role will require close interface and regular communication with TRICARE our client, and with their beneficiaries who are enrolled throughout the Latin America-Canada region. 

The TRICARE Senior Coordinating Nurse will work closely with the Tricare Overseas Program (TOP) Medical and Operations team to drive a quality assured service to our beneficiaries. 

The TRICARE Senior Coordinating Nurse will be responsible for:

2. • Medical case management: including tasks for the Co-ordinating Nurse. 
   • Acting as an escalation point, the Senior Coordinating Nurse discusses cases with the medical team, providing clinical direction and ensuring standards of care are upheld for beneficiaries.
   • Working autonomously to deal with complex cases.
   • Interact with operations and logistical team coordinators to ensure optimal quality case management and service delivery. 
   • Performance of various management and administrative functions in support of the Nurse Manager

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

 Medical Case Management:

• Provide telephonic medical assessment of beneficiaries in our region, refer to appropriate care and monitor the appropriateness of the treatment being received. 
• Speak with treating medical professionals and obtain medical updates for beneficiaries.
• Be responsible for the effective and efficient medical management of cases, meeting TOP contractual deliverables and internal policies and procedures. 

Leading the way:

• Be a source of guidance and support for junior colleagues, this includes:
  • Escalation point for medical team
  • Proactively assisting medical team in case management and “On the spot” training as necessary.
• Deputise for the Nurse Manager as required.
• Demonstrate effective coordination and time management by completing weekly allocations, ensuring appropriate staffing levels across the platform, and balancing operational needs with individual skill sets and availability.
• Assist the Medical Director in leading handover as a point of reference for policy and client demands.
• Promote and reinforce the need for evidence-based medical decision making and advice with clear documentation of the information and source.  
• Liaise with medical and operational staff to facilitate the efficient management and direction of case work.  Drive forward cases with an aim to providing customer service with the greatest efficiency.
• Undertake responsibility for all medical information released ensure consent and confidentiality are maintained as per HIPPA requirements.
• Monitor dashboard within CRM to track case volumes throughout the day, reallocating staff as needed to maintain operational efficiency.  Ensure performance remains with KPI. 
• Identify new and improved ways of case management by identifying and focusing on current platform areas and taking a proactive solution orientated approach.  
• Maintain accurate and confidential member case files in accordance with International SOS policies.
• Always ensure a high level of professionalism.
• To attend internal platform meetings with Ops, Senior Med Mgmt. and Quality team colleagues to promote networking and sharing of good practice.  Maintain progress tracker for LAC specific meetings to reflect platform progress.
• Effective communication with medical and operational colleagues (includes managing conflict and having challenging conversations).
• To mentor new staff, updating medical management and training team of their progress.
• To be accountable for workload and movements to line manager.
• To keep accurate records including statistical information where appropriate.
• To be a professional and approachable role model to all staff.
• To carry out any other reasonable duties and project work as requested by the manager.
• To assist with identifying ways of improving the working environment and sharing these ideas with management to aid staff retention.
• Assist with the recruitment process for LAC Nurses, including participation in interviews and running assessment centres.

Client focus: 

• Professionally communicate verbally and/or in writing to the TRICARE area office the progress of the beneficiaries’ condition and appropriate recommendations.
• Act as a deputy to the Nurse Manager with required and assist the Medical Director in leading handovers and TRICARE Area Office bi-weekly call.

Quality Case Management: 

• To provide medical monitoring of ongoing cases and ensure excellence in case management, with a focus on encouraging optimal quality and efficiencies across the platform.
• To attend global call calibration meetings with clinical training team and global Medical Managers.
• Review cases queries from Quality team and provide a thorough case summary and response within timeframe requested.  Takes responsibility to provide feedback to staff/line management in real time.
• Assist NM in completion of RMM audit as required
• Assist NM in completion of Corrective Action Plans as required

 Escalations:

• Working at a higher and more autonomous level, utilising enhanced skills and competencies, and dealing with more complex patients or cases.
• To be a source of guidance for the Lead Nurse providing case direction and support.  Work to empower the Lead Nurse and provide problem solving discussions to facilitate their growth and confidence
• Escalate to medical and/or operations managers any major medical cases, complaints as per International SOS escalation criteria. 
• To recognise limitations and areas of self-development through reflection. To be responsible for all actions and decisions made, knowing when to defer and escalate to senior members of the medical team.

Required Skills and Knowledge (Brief description of technical knowledge or skills needed to perform the job)

• Broad Medical Knowledge – minimum of 3-4 years consolidated clinical experience. 
• Strong computer literacy skills with experience in Word, Outlook and Excel. 
• Excellent customer service skills.

 Required Competencies (Critical behaviours necessary to successfully perform the job)

• Following Instructions & Procedures:  Appropriately follows instructions from others without unnecessarily challenging authority; Follows procedures and policies; Keeps to schedules; Arrives punctually for work and meetings; Demonstrates commitment to the organisation; Complies with legal obligations and safety requirements of the role.
• Coping with Pressure & Setbacks:  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;
• 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.
• Leadership: Upholds ethics and values; Demonstrates integrity; Establishes effective relationships with clients and staff; Motivates and empowers others; Effective communication which encourages clear dialogue, debate and reflection to promote and discuss ideas in the pursuit of positive outcomes.
• 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.

Required Work Experience (Brief description of the job-related experience needed to perform the job)

• High level of experience in acute care and primary care
• Customer / client focused approach.
• Confidence in clinical decision making.
• Confident with providing clinical leadership and mentoring.

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 or bachelor’s degree in nursing is required from an Accredited nursing program.

Required Languages (Brief description of the language skills needed to perform the job)

• Excellent written and oral English Language
• Spanish desired (but not required).

Travel / Rotation Requirements (Brief description of any travel or rotation requirements)

• None