Overall Purpose Of The Job
Brief description of the primary purpose of this position
Under the direction of the Network Clinical Quality Assessment Manager, and in close collaboration with the local GAN members and TRICARE Relationship Managers, has direct responsibility for auditing and credentialing Tricare providers in a given area of jurisdiction according to the TOP contractual requirements. This includes making trips, site audits, provider credentials and SPIN data maintenance, in collaboration with local GAN and PNS (Provider Network Support).
Under the leadership of the Network Clinical Quality Assessment Manager, working with the Head of Network Administration, and with Local GAN members, prepares Tricare Trips based on utilization & quality feedback, objectives of right-sizing and existing credentialing situation.
Conduct Site audits, using Intl.SOS guidelines and Evaluations Forms, collect credentialing, issue corresponding Trip Reports and ensure follow-up actions are put in place.
KEY RESPONSIBILITIES
- Directly sources service providers on the basis of criteria designed to meet specific Tricare Global contract standards, the requirements of the Intl.SOS medical team, and quality of care considerations. Set up new service level/contract arrangements with suitable medical and non-medical providers in accordance with Tricare, and other program contractual requirements.
- Participates in trips, site audits, provider credentials and SPIN data maintenance as required in order to assess and document provider scope and quality of service. This will require travel.
- In collaboration with the local GAN and the PNS update and maintain the service provider information in the (SPIN) database according to Corporate Guidelines. In particular assessments, reviews, credentials, and professional qualifications must be documented in SPIN, and require regular reviews and updates according to Intl.SOS’ data quality standards.
- Liaises with the PNS and other GAN departments to contribute to the best use of SPIN and a consistent maintenance of the credentials for Tricare- providers, especially to optimize the return on Trips and Site Audits. Quality control and involvement in credentials renewals will require close team work.
- Takes a substantial role in achieving cost containment with Tricare Europe network providers, and promoting and monitoring the cost containment efforts of the other GAN Departments with Tricare Europe network providers. Conducts research on healthcare systems and medical issues as required.
Customer Care and Networking
Be accessible and responsive to clients and colleagues questions, concerns and requests for information. On the basis of requests, identify areas where training can reduce the workload of the GAN Department and improve overall productivity of Intl.SOS.
Build positive and effective relationships with local network providers (medical and administrative representatives), with local Tricare Point of Contact and members of US Health Units.
Good communications is essential to success in this role. Therefore, it is important to be accessible and responsive to clients and colleagues questions, concerns, and requests for information. And prepare weekly progress reports.
Deal positively with complaints, resolving these wherever possible on a timely basis, and/or referring them to the appropriate department or the Tricare Network Head Nurse.
Job Profile
Required Skills and Knowledge
Brief description of technical knowledge or skills needed to perform the job
- Evidence of broad clinical knowledge.
- Ability to assess/audit in a structured incisive manner.
- Excellent communication, presentation and interpersonal skills.
- Excellent organizational and planning skills.
- Ability to negotiate and influence across a wide spectrum of people and disciplines.
- Multicultural experience.
- Ability to develop, build and maintain partnerships across a diverse range of internal and external clients and providers.
- Audit, report writing and project management skills.
- Ability to analyze provider financial information and to utilize data in support of negotiations.
- IT literate and conversant with contemporary computer software.
- Ability to work on own initiative and within broad guidelines.
- Flexible to travel at short notice.
- Strong team-worker.
- Customer/Service Provider focused with a willingness to deliver service using best practice methodology.
- Proactive and forward thinking, with an ability to resolve issues in a positive and advantageous way.
- Self-starter.
- Not afraid to take a risk in challenging and questioning the way things are done.
- Keen to succeed within a demanding and ever-changing environment.
Required Competencies
- Customer-oriented attitude
- Team player
Required Work Experience
Brief description of the job-related experience needed to perform the job
Graduate nurse with a minimum of 3 years nursing experience
Experience in one or more of the following fields:
- Healthcare quality management/assurance.
- Medical facility accreditation in one or more areas.
- Implementation or conducting of medical facility or departmental review/audit programs.
- Medical facility administration in the provision of healthcare services.
- Medical outsourcing of services to provider networks.
- Healthcare network development / management.
- Familiarity/experience with international healthcare – either working/interfacing in an international healthcare environment.
- Healthcare insurance or medical/travel assistance in the area of managed healthcare utilizing provider networks.
Required Qualifications
Brief description of the educational background needed to perform the job
Graduate nurse with a minimum of 3/5 years nursing experience
This position does require someone who can obtain a Tier 1 background investigation for a position of trust after being offered a position and maintaining after starting with International SOS
Required Languages
Brief description of the language skills needed to perform the job
Fluency in English and Spanish
Travel / Rotation Requirements
Brief description of any travel or rotation requirements
Regular travel required
International SOS Government Services, Inc. requires all employees to be fully vaccinated against COVID- 19, where allowed by law.
International SOS is an equal opportunity employer and does not discriminate
Apply Now