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Referral Management Liaison TRICARE - Honolulu, HI

UnitedHealth Group


Location:
Honolulu, HI
Date:
06/29/2017
2017-06-292017-07-28
Job Code:
1757295
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Job Details


Referral Management Liaison TRICARE - Honolulu, HI(Job Number:718794)
Description

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

The primary purpose of the Referral Management Liaison is to serve our customers by addressing authorization / referral issues through fast and accurate problem identification, routing to the appropriate department or  Vice President of Market Operations (VPMO) and Director of Market Operations (DMO) when applicable.

Primary functions are performed at a Military Treatment Facility (MTF), on a military installation.

The Referral Management Liaison (RML) serves as the Referral Liaison for all MTF referrals and authorizations / provider support, and Medical and Case Management (CM). Works with the Lead RML and the VP / DMO to assist in building and maintaining relationships between the UnitedHealthcare Military & Veterans (UHC M&V) team, and MTF staff and leadership. Underlying all of these functions are two over-arching goals; optimize TRICARE beneficiary health and healthcare, and the utilization of MTFs.

Primary Responsibilities:

  • Maintain ongoing communications with the MTF Referral Management Center and MTF TRICARE Operations staff to resolve identified referral and authorization issues.
  • Process STAT and Urgent referrals from the MTF, as well as assist in the processing of a minimum daily average of five routine referrals within the geo - pod with an expectation of processing additional referrals as capacity allows.  Assist MTF staff with inquiries correspondence, claims issues and Urgent referrals.
  • Correct misdirected referrals.
  • Supports Medical Management team on improvement in Referral Processing, Utilization Management (UM), CM, and Integrated Behavioral Health (IBH) initiatives by identifying and tracking systemic issues and supporting implementation of resolution as needed.
  • Collaborate with the MTF staff to identify and refer patients for potential CM, Disease Management (DM) or other services, in accordance with UHC M&V processes.
  • Operate in compliance with UHC M&V policies, procedures and performance standards.
  • Maintain close communications with the Lead RML or VP / DMO.Actively participate in meetings with MTF staff pertaining to primary responsibilities.
  • Assist the VPMO / DMO in planning meetings with the MTF.
  • Deliver or assist in presentations about TRICARE when Beneficiary Education Representatives (BER) and Beneficiary Enrollment Specialist (BES) are unavailable.
  • Identify and report potential risk management and quality of care issues to the Lead RML, and / or the VPMO / DMO.
  • Provide information to the MTF on the availability of local healthcare resources and programs as requested.
  • Provide assistance to civilian providers with benefits, referrals, claims, Right of First Refusal (ROFR) process, Command Approvals, and eligibility in partnership with Provider Services or the Network Manager.
  • Occasionally, may accompany Provider Relations personnel on provider visits, as requested, to educate them on referral process, claims, as requested by the MTF to maintain local provider relationships.
  • RML's assigned to support Parent MTFs or USCG Districts will have responsibility for multiple sites.
  • Responsibilities will include acting on behalf of the Lead RML and VPMO / DMO as needed.
  • Perform other duties as assigned.

Job Service Account Management
Primary Location US-HI-Honolulu
Other Location 
Organization M&V Field Ops
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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