TRICARE Nurse Manager

About the role

Ensure excellence in TRICARE case management, driving focus on quality and service delivery per TRICARE guidelines and TOP Contract specifications and expectations. Support the ongoing development of the TRICARE Medical Team and ensure satisfaction and positive outcomes with beneficiaries, client personnel and providers.

Key responsibilities

SPECIFIC SUPERVISORY RESPONSIBILITIES

• Oversee the allocation and progression of work for the team. This involves properly allocating transmissions and cases to team members of appropriate capability and ensuring that tasks and actions are completed within expected timeframes.
• Assist the TRICARE Medical Director by monitoring progress on complex or high priority cases to ensure that all service standards are met.
• Responsible for confirming that adequate staff coverage is scheduled to support case management.
• Drive the focus on quality of data capture, accuracy of recommendations and case direction within the framework of case management.
• Proactively manage cases and direct cases escalated, with a focus on medical actions that lead to effective case management and patient oversight.
• Serve as primary point of escalation and supervision for any functional and medical issues related to the Claims /Utilization Review nurses.
• Escalate any medical or functional issues regarding the Claims / Utilization Review nurses to the TRICARE Medical Director as may be deemed necessary.
• Act as primary point of technical expertise for the Medical Team providing guidance and advice to resolve conflicts and issues and escalating to the appropriate resource for assistance as may be necessary.
• Strategically review staffing model to ensure it supports the TRICARE platform providing metrics and numbers to justify new staffing models as may be required to support caseload and maintain quality standards. This includes budgeting new positions based on projected membership usage, business growth and staff attrition.  

STAFF SUPPORT AND DEVELOPMENT

• Actively recognize high-performing staff and create development plans to address their specific strengths, keeping the TRICARE Medical Director updated of these developments.
• Oversee senior nurse coordination of induction training and learning and development across the platform.
• Participate in performance reviews quarterly in preparation for annual review..
• Ensure that the TRICARE nurses actively pursue their Continuous Professional Development and that they are supported in their pursuit of such opportunities.

CASE ESCALATION

• Escalation as per Intl. SOS protocol to the TRICARE Medical Director, Regional Medical Director and Corporate Assistance Department (CAD), in that order respectively.

BUSINESS DEVELOPMENT

• Participate in appropriate business development activities to enhance the development of Intl. SOS activities, under the direction of the Regional Medical Director and CEO - Americas in consultation with the Marketing Manager.
• Assist in explaining International SOS medical services to prospective and existing clients as requested.

MISCELLANEOUS

• Undertake client specific training on unique software or program requirements to fulfill the expectation of the contract and client. 
• Be responsible for personal Continuing Professional Education. 
• As one of the managers in operations, play a leading role in case management and team development, working closely with the Operations Manager and Shift Supervisors.
• Attend supervision, training and departmental meetings as may be required.
• Undertake accountability for personal workload.
• Participate in Coach2Win, Peer-Mentor, Training-Mentor and similar programs as may be requested.

About you

• Registered Nurse with valid registration in the country where employed
• High level of broad medical knowledge with previous acute care experience.
• High level experience in delivering teaching and training to an internal and external audience (clients, other organizations, senior stakeholders)
• Previous experience in supporting and developing teams to share and promote best practice.
• Flexibility to travel as required.