UnitedHealthcare Military and Veterans is currently seeking a Service Center Manager. Primary functions are performed in a TRICARE Service Center (TSC) located in a Military Treatment Facility (MTF), on a military installation. Manages the activities of the TSC to ensure compliance with contractual requirements and maintenance of customer service standards. Serves as the primary liaison for the MTF regarding TSC operations, enrollment, network adequacy/availability, and referral/authorization issues. Works with the Vice President of Hawaii Market Operations (VPMO) and Field Clinical Coordinator to assist in building and maintaining relationships between MTF staff and civilian providers and facilities; supports MTF Optimization initiatives.
- Manages TSC and staff operations at five (5) Hawaii TSC locations
- Tripler Army Medical Center (physical location)
- Naval Health Clinic Hawaii, Makalapa (Pearl Harbor)
- Naval Health Clinic Hawaii, Marine Corps Base Hawaii (Kaneohe)
- 15th Medical Group (Hickam)
- U.S. Army Health Clinic, Schofield Barracks
- Conducts ongoing TSC staff development activities, including routine performance feedback and counseling.
- Ensures implementation and compliance with UnitedHealthcare Military & Veterans (UHC M&V) policies, procedures and performance standards.
- Maintains close communications with the VPMO regarding TSC operations, communications, MTF issues, local network, and Hub.
- Actively participates in meetings and communications with MTF staff.
- Assists the VPMO in planning meetings and participates in those meetings.
- Ability to deliver a variety of prepared presentations about the TRICARE program to small and large groups.
- Facilitates special coordination of beneficiary care issues between the UHC M&V Corporate resources
- Participates in meetings, studies, and training as directed by the VPMO
- Maintains ongoing communications with the MTF Hawaii Referral Center and/or MTF TRICARE Operations staff to resolve identified referral and authorization issues.
- Identifies and reports potential risk management and quality of care issues to the VPMO, Regional CEO and/or medical management staff as indicated
- Provides information to the MTF on the availability of local area healthcare resources and programs
- Participates in performance improvement activities
- 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
- Performs other duties as assigned
- Regular and reliable attendance is required
- Responsibilities will include acting on behalf of the VPMO as needed
- High School Diploma/GED
- 3 + years of documented supervisory experience
- 2 + years of documented experience working in customer service (phone or face-to-face) environments (i.e. direct contact with customers)
- Valid drivers license; access to a registered vehicle
- United States Citizenship
- Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86.
As a requirement of UnitedHealth Groupâ€™s contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 http://www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or â€œNACâ€). Successful completion of the NAC process is a requirement for continued employment in this role. NAC 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 NAC approval will result in termination from this role.
- Thorough knowledge of TRICARE and the Military Health System is strongly desired
- 5 + years of clinical nursing experience is preferred
- Current and unrestricted Nursing license in the State Of Hawaii is a plus
When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. Thatâ€™s why UnitedHealthcare is the organization thatâ€™s called on to serve them and their loved ones. Weâ€™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. Itâ€™s a genuine opportunity to do your lifeâ€™s best work.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Key words: Honolulu, HI, Hawaii, Call Center Manager,Call Center, Manager, UM, CM, Case Management, Supervisor, Supervisory, Customer Service, Customer Service Manager, Tripler Army Medical Center, Naval Health Clinic Hawaii, U.S. Army Health Clinic
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