TriWest Healthcare Alliance

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Recruiting Location Phoenix, AZ
ID 2020-3129
Job Summary   Provides crisis intervention counseling and referral services for DSPO beneficiaries and other eligible beneficiaries through the 24-hour Behavioral Health crisis line. Conducts telephone triage for crisis calls and provides appropriate documentation for those calls.
Recruiting Location Phoenix, AZ
ID 2020-3128
Do you bring creativity and innovative, ‘out-of-the-box’ ideas to your work?  Do you have healthcare and/or quality experience?   How about Lean or OpEx?  If so, we might be a fit.  TriWest Healthcare Alliance has been on a Mission to serve our nation’s Veterans and their families since 1996.  We are an evolving team of professionals that will do “Whatever it Takes” to serve our nation’s heroes in partnership with the VA.  We looking for a dynamic change agent to help us reinvent and reinvigorate our processes while establishing and driving and a best-in-class quality culture.   Reporting to the Director of Quality and Process Improvement, spearheads the development of quality improvement programs, manages Quality Improvement operations and staff, and coordinates administrative quality data and information for quality committees and the Board of Directors.  Performs complex analysis and leads resolution to operational problems.  Decision making is focused on implementing practical, timely solutions.  Assesses the impact of quality improvement initiatives across TriWest.  Collaborates and develops consensus with senior leadership and staff at all levels.  Communicates and collaborates cross-functionally with a broad scope of project plans and risk management activities.  Operates with a thorough understanding of healthcare business processes, URAC and ISO standards.  Participates in new program development as necessary.
Recruiting Location Phoenix, AZ
ID 2020-3127
Taking Care of Our Nation’s Veterans.   It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Sr. Communication Specialist?      Assists in the research, development, implementation and monitoring of the company's internal and external communications programs. Serves as a chief writer/editor for corporation, including executive messaging. Assists in the planning and support of internal campaigns and special events. Contributes to the development and manages internal and external communication plans, documents and programs. Manages content and approvals for TriWest’s Intranet site.
Recruiting Location Phoenix, AZ
ID 2020-3126
Taking Care of Our Nation’s Veterans.   It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Medical Director?    Oversees and participates in clinical quality reviews, peer review, and provider interactions. Works closely with and oversees clinical staff reviewing potential quality issues and appropriateness of care. Develops provider and system-based corrective action plans as needed. Chairs and coordinates quality and other committee meetings as assigned. Documents reviews of clinical quality and appropriateness of care in the medical management system. Collaborates with VA, network providers, and TriWest staff to assure timely, appropriate and high quality care. Uses data to facilitate and optimize the delivery of health care services. Interacts directly with beneficiaries, as indicated, to assure a high level of satisfaction.
Recruiting Location Phoenix, AZ
ID 2020-3125
Do you bring creativity and innovative, ‘out-of-the-box’ ideas to your work?  Do you have healthcare and/or quality experience?   How about Lean or OpEx?  If so, we might be a fit.  TriWest Healthcare Alliance has been on a Mission to serve our nation’s Veterans and their families since 1996.  We are an evolving team of professionals that will do “Whatever it Takes” to serve our nation’s heroes in partnership with the VA.  We looking for a dynamic change agent to help us reinvent and reinvigorate our processes while establishing and driving and a best-in-class quality culture.   Reporting to the Director of Quality and Process Improvement, spearheads the development of quality improvement programs, manages Quality Improvement operations and staff, and coordinates administrative quality data and information for quality committees and the Board of Directors.  Performs complex analysis and leads resolution to operational problems.  Decision making is focused on implementing practical, timely solutions.  Assesses the impact of quality improvement initiatives across TriWest.  Collaborates and develops consensus with senior leadership and staff at all levels.  Communicates and collaborates cross-functionally with a broad scope of project plans and risk management activities.  Operates with a thorough understanding of healthcare business processes, URAC and ISO standards.  Participates in new program development as necessary.
Recruiting Location Phoenix, AZ
ID 2020-3124
Manager, Clinical & Bus Insight at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   This role manages healthcare data reporting, querying, and analysis for the Data Management department with direct responsibility for healthcare utilization and cost analysis. Oversees a team of Clinical Analysts and Business Intelligence Analysts tasked with providing TriWest leadership with insights from clinical, operational, and performance data. Monitors performance on healthcare discounts and identifies opportunities to improve. Evaluates utilization patterns and develops analysis with recommendations to optimize network to better complement the Government healthcare system and help TriWest meet goals related to access to care and discount targets. Supports strategic initiatives related to healthcare cost management performance objectives and contractual reporting. Drives the organization towards data-driven decision making.
Recruiting Location Phoenix, AZ
ID 2020-3123
Manager, Systems Engineering at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Utilizes balanced knowledge and approach against technical, people, and process tracks. Provides guidance of high performing technical team, which supports extremely complex, highly secured environment. Team provides server and application support functions in highly virtual environment. Manages team with expert knowledge of Windows systems design based on Microsoft best practices. Participates in and coordinates efforts for the design, architecture, implementation, and maintenance of highly available / highly secure computing environment.
Recruiting Location Phoenix, AZ
ID 2020-3121
Job Summary   This position supports the department leadership in the overall management of provider education as it relates to TriWest provider networks. Ensures high level of customer satisfaction by serving as the consulting resource for the Provider Services Department and TriWest network subcontractors. Serves as the subject matter expert by educating providers on TriWest reimbursement methodologies, provider education content, contract requirements, and new programs. Responsible for developing provider education materials and operates as intermediary between network subcontractors and TriWest staff on provider education needs. Facilitates resolution of escalated provider issues and communicates outcomes.. Ensures compliance with network subcontractor statement of work requirements and overall account management for assigned states. This position supports the Veterans Affairs Patient-Centered Community Care Program (VAPC3) and is responsible for delivering primarily virtual education, as well as and in-person training to both providers and network subcontractors. This position must keep current and follow VA, TriWest, and departmental policies and procedures and submit reports in a timely manner. Assigned territory may cover four to nine states.   This position is also responsible for delivering primarily virtual education to both network subcontractors and providers. This position must keep current and follow VA, TriWest, and departmental policies and procedures and submit reports in a timely manner. Assigned territory may cover four to nine states in the designated VA Region      
Recruiting Location Phoenix, AZ
ID 2020-3119
Taking Care of Our Nation’s Veterans.   It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Program Integrity Support Specialist?     This position is under general guidance of the Director, Corporate Compliance and reports directly to the Supervisor, PI Specialist. The PI Support Specialist is responsible for providing claim processing and administrative support for Program Integrity (PI) investigations, law enforcement requests for information, other internal/external Fraud, Waste and Abuse (FWA) case development activities. The PI Support Specialist utilizes healthcare billing, claim processing, and medical record knowledge, in addition to research skills, to review and process of medical/surgical and behavioral health claims according to protocol directions established by PI Specialist. The PI Support Specialist captures savings and recoupment calculations, and reports on PI provider flag efficiencies. The PI Support Specialist compiles claim data, provider contracts, bank accounts, patient files (including, but not limited to medical records and claim images) and other information necessary to respond to law enforcement subpoenas related to FWA investigations.  The PI Support Specialist accurately records case referrals, claim activity, and law enforcement information requests, and assists the PI Supervisor with departmental reporting requirements. Ensures strict compliance with court appearance deadlines and HIPAA Privacy Rules.
Recruiting Location Phoenix, AZ
ID 2020-3118
Taking Care of Our Nation’s Veterans.   It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Program Integrity Specialist?     This position is under the general guidance of the Director, Corporate Compliance and reports directly to the Supervisor, PI Specialist.  The PI Specialist is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA) and the Healthcare Finance Administration (HCFA); requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).  Complies with the Veterans Affairs Patient-Centered Community Care (PC3) and Veterans Choice Program (VCP) contracts and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies  interfaces directly with Veterans, providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters;  prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals.
Recruiting Location Phoenix, AZ
ID 2020-3113
Sr Workload Reporting Analyst at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Sr Workload Reporting Analyst?
Recruiting Location Phoenix, AZ
ID 2020-3110
Job Summary   This position is responsible for providing leadership in the development, implementation and oversight of all Provider Data and Credentialing functions in alignment with organizational strategic initiatives while ensuring a collaborative, open and inclusive work environment that is focused on quality outcomes and superior customer service. Accurate provider data and credentialing is central to pay or organizations so this position must drive for timely data processing with highest degree of accuracy possible. This position serves as the primary advisor to the organization and subject matter expert on matters related to assigned area of responsibility. Also directs, plans, develops, and implements performance standards, quality improvement, and delivery of service to create a positive impression of TriWest with its providers. This position is responsible for serving as a role model throughout the organization and representing TriWest in a positive manner both within and outside the organization.        
Recruiting Location Phoenix, AZ
ID 2020-3107
Are you a driven and independent individual? Do you have healthcare and/or project management experience? Do you expect great results out of yourself and others? If so, we might be a fit. TriWest Healthcare Alliance has been on a Mission to serve our nation’s Veterans and their families since 1996. We are an evolving team of professionals that will do “Whatever it Takes” to serve our nation’s heroes in partnership with the VA. We are looking for talented individuals with a unique blend of skills to advance our organization through project management.    Responsible for leading and managing large, complex, cross-functional project initiatives for an industry-leader supporting healthcare needs of the nation’s Veterans and military members.  Works within a dynamic, fast paced Enterprise Project Management Office (ePMO); understands and values project management; encourages professional development and empowers its staff to achieve their best. The Sr. PM applies recognized project management concepts, professional discipline, ethics and conduct standards to deliver a wide range of integrated enterprise applications, services and results. Leads, manages, develops and implements various-sized, cross-functional, enterprise wide projects. Responsible for monitoring and reporting on individual business and IT projects and initiatives. Produces detailed and comprehensive plans, reports, analyses and recommendations. The work is accomplished through a matrix of project and functional managers and departments focused on managing changes in business operations, products or services delivery and implementing improved changes.   Establishes, maintains and carries out active and effective risk and change communications among stakeholders. Serves as a project management role model, trainer, coach, mentor for the organization. Success is measured in terms of completing the project within the defined constraints and compliance with methodologies and best practice. This position reports to the Director, ePMO.
Recruiting Location Phoenix, AZ
ID 2020-3106
Are you a driven and independent individual? Do you have healthcare and/or project management experience? Do you expect great results out of yourself and others? If so, we might be a fit. TriWest Healthcare Alliance has been on a Mission to serve our nation’s Veterans and their families since 1996. We are an evolving team of professionals that will do “Whatever it Takes” to serve our nation’s heroes in partnership with the VA. We are looking for talented individuals with a unique blend of skills to advance our organization through project management.    The Senior Program Manager is responsible for ensuring that enterprise wide programs are well defined, planned, tracked and communicated in a consistent manner; responsible for building partnering relationships within stakeholders; responsible for on time, within budget and quality implementation of enterprise wide programs; responsible for executing project management best practices. 
Recruiting Location Phoenix, AZ
ID 2020-3104
Job SummaryDirects multiple large TriWest projects, working closely with program managers, project managers and business leaders to understand and report quality and performance issues and address systemic concerns. Diagnoses and implements solutions. Conducts quantitative and qualitative analysis and assessment of TriWest programs, processes, and outcomes. Utilizes quantitative tools and techniques to perform data-based analysis. Utilizes consulting and facilitation approaches for qualitative assessments. Produces complete and informative, reports, describes options in terms of cost/benefit, and makes recommendations to leadership and/or user groups for process/program improvement and/or decision-making. Supports project implementation when required using project management tools to develop project plans/timelines, coordinate/manage project, monitor and report status, progress and areas of risk in relation to established project objectives, requirements and timelines. Works quickly and thoroughly to perform analyses, report results, produce deliverables and support implementation on time.Education & ExperienceRequired: oBachelor’s degree in Business Administration, Management Information Systems, Finance, Engineering, Healthcare Administration, or related field; or equivalent experience.o5+ years’ experience in project managemento5+ years’ experience managing complex projects/teamso4+ years’ experience in business analysis, process improvement, and/or consultingoHealthcare experience in Operations, Managed Care, Finance, and/or Medical ManagementoExtensive experience in business model development and analysisoExtensive experience with multiple databases, Excel, SQL, and other reporting and statistical toolsoExperience in process and program improvement and business and operational planningoExperience in delivering quality and efficiency gains as a result of process and program improvement project managementoExperience in managing multiple projects simultaneouslyoExperience preparing presentation and reports.Preferred: oMaster’s degree in Business Administration, Healthcare Administration or related fieldo5+ years’ experience in project management, with projects supporting senior and C-suite leaders o5+ years’ experience managing complex projects/teamso5+ years’ experience in business analysis, process improvement, and/or consultingoCertification in Lean Six Sigma Green Belt or Black Belt oHealthcare, management or analytical consulting experience0 Experience and knowledge of the VA health system and/or Military Health System,Key ResponsibilitiesoLeads multiple complex projects and/or teams, applying project management tools and methodologies.oPrepares detailed qualitative and quantitative assessments of processes and programs that result in measurable quality, efficiency and effectiveness improvement recommendations and outcomes0 Creates complex project planning documents using software programs, including process flow diagrams, work plans, timelines and Gantt charts. Creates status reports and provides regular updates to leadership.oModels effective leadership skills, communicates sensitively with others about their areas of responsibility. . oCollaborates with business units to learn and understand their processes and translate into meaningful process improvements.oAnalyzes and reports data, market trends, government regulations, and breaking news related to project plans.oPrepares and analyzes detailed business plans including cost benefit analysis for medium and long-term objectives. oTrains staff on program objectives, process models and analytical tools.oRegular and reliable attendance is required..: CompetenciesCommunication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.Computer Literacy: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approachInformation Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment.Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.Problem Solving / Analysis: Ability to solve problems through systematic qualitative and quantitative analysis of processes with sound judgment; Has a realistic understanding of relevant issues.Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment.Technical Skills: Knowledge of the Managed Care concepts, proficient with statistical analysis, data management and analysis, project management techniques, benchmarking practices and techniques, quality improvement tools and techniques, presentations skills, and proficient with Excel, SQL, Word, PowerPoint, and Visio
Recruiting Location Phoenix, AZ
ID 2020-3101
Sr. Business Process Analyst at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Manager, Business Applications?   Do you find satisfaction providing expertise in gathering business rules, developing process design, and implanting process solutions? Do you enjoy collaborating with relevant departments to design process flows, create process change documentation, & validate process change in alignment with TriWest business needs and Veteran’s Administration’s Healthcare requirements? Do you thrive on facilitating meetings, identifying, collecting, organizing and prioritizing process requirements and business processes changes to meet business requirements? Are you looking for a job that is meaningful and rewarding?   If you enjoy clarifying complex business issues, recommending solutions, and advocating business process improvement through data analysis, process change and technology application, we have a position for you.  
Recruiting Location Phoenix, AZ
ID 2020-3100
Job Summary   Coordinates incoming correspondence in Provider Services; including reviewing and researching the issue/request, maintaining a log of all requests received, and electronically distributes all requests to the appropriate department/staff within expected timeline(s). Ensures all provider agreements received in Provider Services are appropriately and timely scanned/imaged into the contract management system; including reviewing the agreement for any redlined changes, maintaining a log of all agreements received and quality controls the agreement image.          
Recruiting Location Phoenix, AZ
ID 2020-3095
Manager, QA and Testing at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996       Manager of Quality Assurance is responsible for the effective development and implementation of software quality assurance (SQA) programs to ensure that all software programs and products meet minimum organization standards and end-user requirements. Ensures adequate product testing prior to implementation and automated testing in support of software deployments and system changes. Through the Quality Assurance team, establishes and maintains Software Quality Assurance (SQA) standards, procedures and controls. Works with software engineering and development during product creation and establishes checkpoints for testing new products. Initiates corrective action for product deficiencies and provides senior technical expertise for software program troubleshooting.
Recruiting Location Phoenix, AZ
ID 2020-3086
Business Intelligence Analyst at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.     The Business Intelligence Analyst is customer focused and facilitates turning data into information to drive business processes and monitoring. The position collaborates to ensure relevant analysis and complete, timely reporting is provided to meet TriWest business needs and Veteran’s Administration’s Healthcare requirements. Facilitates meetings, identifies, collects, organizes and prioritizes data requirements and business processes changes to meet reporting requirements. Clarifies complex business issues and recommends solutions. Advocates business process improvement through data analysis, process change and technology application.  
Recruiting Location Phoenix, AZ
ID 2020-3068
This Position is located in Phoenix, AZ Claims Call Center Representative  at TriWest Healthcare Alliance   Taking Care of Our Nation’s Veterans. It’s Who We Are. It’s What We Do.   Do you have a passion for serving those who served?   Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!   Our job is to make sure that America’s heroes get connected to health care in the community.   At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.   Are you our next Claims Call Center Rep?