Care Coordinator TRICARE

About the role

Profile: We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MI, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary: Coordinates transitions of care for TRICARE beneficiaries. Care Coordinators receive inbound calls and make outbound calls to support care coordination needs across the TRICARE West Region. Care Coordinators report to the Supervisor, Care Coordination.

Requirements

• Licensed Practical or Vocational Nurse (LPN/LVN), with current unrestricted license in appropriate state or territory of the United States
• U.S. Citizenship
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 2+ years’ clinical nursing experience
• Proficiency in medical data entry, written skills and Microsoft Office
• Exceptional oral communication skills, strong organizational skills and easily adapts to change

Preferred:

• 3 years’ clinical experience
• 2+ years’ Managed Care experience

Responsibilities

• Utilizes clinical and analytical skills to identify care coordination needs and facilitate care during any type of transition of care.
• Communicates with community providers, TRICARE beneficiaries, Military Treatment Facilities (MTF), Veterans, VAMCs and facilities to coordinate care.
• Ensures authorizations are in place to meet clinical care needs.
• Accurately and completely document coordination activities in the Medical Management System (MMS).
• Refer cases to other TRICARE programs as indicated.
• Participates in Quality Improvement Projects as indicated in project documents.
• Identifies