Position Description:We're looking for an organized individual who demonstrates professionalism and a strong work ethic to assist the members of the Military and their dependents.Primary functions are performed at a Military Treatment Facility (MTF), on a military installation. The MTF Referral Liaison serves as the Referral Liaison for all MTF referral/authorization situations, as well as network/provider support, enrollment/PCM changes, medical and case management, education and claims assistance. Works with the Vice President of Market Operations (VPMO)/Director of Market Operations (OMO) to assist in building and maintaining relationships between MTF staff, civilian providers and facilities; and supports MTF Optimization initiatives.Primary Responsibilities:Acts as primary Referral Liaison for the MTF by completing referral and authorization actions at the request of Referral Management Center staff. Maintains ongoing communications with the MTF Referral Management Center and / or MTF TRICARE Operations staff to resolve identified referral and authorization issues. Process STAT and Urgent referrals received from the MTF.Assists various MTF staff with inquiries utilizing UHC M&V tools and processes: status of enrollment, correspondence, billing and payment, processes Urgent referrals, corrects misdirected referrals, etc.Participates as a team member with Medical Management regarding Referral Processing, Utilization Management (UM), Case Management (CM), and Integrated Behavioral Health (IBH) initiatives.Collaborates with the MTF staff to identify and refer patients for potential CM, DM or other services, as indicated per UHC M&V processesAssists with coordinating In and Out ProcessingMay supervise a small number of Referral Management LiaisonsEnsures implementation and compliance with UnitedHealthcare Military & Veterans (UHC M&V) policies, procedures and performance standards.Maintains close communications with the VPMO / DMO regarding MTF issues.Actively participates in meetings and communications with MTF staff.Assists the VPMO/DMO in planning meetings and participates in those meetings.Delivers or assists with a variety of prepared local / Military installation / MTF-level presentations weekly / monthly about the TRICARE Program to small and large groups, including support / conduct of beneficiary education briefings/events and in-processing / out - processing activities, as requested and/or required by installation / MTF leadership / staff.Facilitates special coordination of beneficiary care issues between the MTF and UHC M&V Corporate resources.Participates in meetings, projects and training as directed by the VPMO / DMO.Identifies and reports potential risk management and quality of care issues to the VPMO / DMO, Regional CEO and/or medical management staff as appropriate.Provides information to the MTF on the availability of local area healthcare resources and programs.Provides phone assistance to civilian providers with benefit, referral and claims issues, ROFR processes, command approvals, and eligibility questions in partnership with local Provider AdvocateMay accompany local Provider Advocate on provider visits, as requested, to provide education on referral process, claims to maintain local provider relationshipsPerforms other duties as assignedRegular and reliable attendance is requiredResponsibilities will include acting on behalf of the VPMO / DMO as needed
Requirements:High School Diploma / GED or higher 1+ years of customer service experience 1+ years of experience and knowledge of the Military Health System OR 1+ years of Civilian Healthcare ExperienceAbility to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86. Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area (5% travel – maybe once a quarter) Candidates must have MTF - required immunizations and TB test where required.United States CitizenshipAssets:Active, unrestricted LPN or RN License Knowledge of TRICAREExperience with MS Word (documentation creation and data entry), Excel (able to open and review spreadsheets) and Outlook/email experience (creating/sending emails, calendar) Soft Skills:Strong verbal and written communications skills.Take the next step, online at: http://www.yourlifesbestwork.com/ As a requirement of UnitedHealth Group's contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense eQuip Form SF86, (the National Agency Check Legal and Credit or "NACLC"). Successful completion of the NACLC process is a requirement for continued employment in this role. NACLC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NACLC approval will result in termination from this role.Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That's why UnitedHealthcare is the organization that's called on to serve them and their loved ones. We're all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It's a genuine opportunity to do your life's best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: UHG, UnitedHealth Group, Service Account Manager, Mountain Home, ID, RN, LPN, TRICARE, VPMO, DMO, customer service, healthcare, MTF
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.