Job: ECHO Coordinator-LPN

COMPANY OVERVIEW
TriWest Healthcare Alliance, headquartered in Phoenix, Arizona, manages and administers quality healthcare services for our nation's active and retired uniformed military service members and their families, through a contract with the Department of Defense.

These individuals are eligible for the DoD's regionally managed health care program for the military, called TRICARE. TriWest manages and administers TRICARE throughout the 21-state TRICARE West Region.

In addition to supporting military families through the TRICARE program, TriWest has developed relationships with organizations such as the USO, Fisher House, the Women in Military Service for America Memorial Foundation and other military relief and support associations to strengthen America's military community locally and nationally.

TriWest provides state-of-the-art facilities, a smoke/tobacco-free, drug-free, business casual working environment, and offers a competitive compensation package including excellent benefits.

For more information about TriWest, please explore our website at www.triwest.com.

DOD STATEMENT
You are applying for a position that involves working on electronic systems that have access to Department of Defense ('DoD') systems. Therefore, you must undergo a DoD background investigation. This requires you to submit an application describing the previous 7 years of your life and to provide proof of U.S. citizenship in the form of a certified birth certificate, certificate of naturalization, current passport, form FS-240 or form DS-1350. This process takes several months to complete. During this time, the DoD will grant interim access to U.S. citizens allowing them to work for TriWest until their background investigation is completed. However, the DoD will not authorize interim access for non-U.S. citizens. If you are unable to obtain interim access or pass the background investigation, you are not qualified for this position and TriWest will withdraw any offer of employment or terminate your employment immediately.

JOB SUMMARY/DESCRIPTION
Job Summary: Conducts review of documentation to determine eligibility for registration in the Extended Care Health Option (ECHO) Program. Key-enters enrollment in the medical management information system. Maintains a caseload of 200-300 beneficiaries enrolled in the program and provides benefit coordination. Functions as a Subject Matter Expert on ECHO program and benefits. Conducts Medical / Surgical medical necessity reviews for requested services. Compiles information needed to process prior authorization requests and documents in the medical management system. Prepares and presents cases for Medical Director review. Identifies needs for process improvement and recommends changes. Advises non-clinical staff on clinical and coding questions. Collaborates with TriWest corporate staff and field staff to support ECHO Program.

Key Responsibility Areas:
o Acts as a Point-of-Contact for beneficiaries, Military Treatment Facility staff, and TriWest staff regarding ECHO eligibility criteria and program registration.
o Conducts timely review of documentation to determine eligibility for registration in the ECHO program and follows-up with appropriate notification of parties.
o Completes accurate data entry for ECHO Program in the medical management information system.
o Maintains a caseload of 200-300 beneficiaries enrolled in the ECHO program and provides benefit coordination services for those beneficiaries.
o Contacts beneficiary or providers to obtain or clarify information.
o Conducts prior authorization activities and referral management activities.
o Assesses medical necessity by screening available information against established criteria, using InterQual Clinical Guidelines, Clinical Decision Support Tool, and TRICARE Policy Manual.
o Performs timely reviews of information including medical management system data or medical reports, including research, investigation, analysis and preparation of summaries with recommendations based on the results.
o Prepares cases for Medical Director Review.
o Researches and collaborates with appropriate community resources to support beneficiaries.
o Identifies and reports potential fraudulent cases to Internal Audit & Corporate Compliance department for review.
o Completes annual re-evaluation of ECHO eligibility.
o Assists ECHO Case Managers as required.
o Refers cases to Case Management or Population Health Improvement as appropriate.
o Performs other duties as assigned.

Working Conditions:
o Availability to work any shift
o Works within a standard office environment, with minimal travel
o Extensive computer work with telephone headset
o Fast paced environment with mandatory contract compliance timelines
o Department of Defense security clearance required

QUALIFICATIONS
Education & Skills:
Required
o Licensed Practical Nurse, with current unrestricted license in appropriate state
o 2+ years experience with Medical / Surgical
Preferred
o 5 years experience with Medical / Surgical
o Managed Care experience
o Working knowledge of medical coding

BENEFITS
TriWest offers a comprehensive and progressive benefits package that includes:

o Medical, dental and vision coverage
o Generous paid time off
o 401(k) Retirement Savings Plan (with matching)
o Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
o Voluntary plans such as pet insurance, long-term care and 529 College Savings Plans
o Reimbursement for various wellness initiatives
o Tuition reimbursement