Description:
Job Duties and Responsibilities:
Responsible for medical due diligence and case direction with respect to designated medical assistance cases across the TRICARE platforms (i.e. incoming calls, inpatients, high priority cases, policy reviews).
Responsibility for designated medically related tasks on all medical assistance cases across the TRICARE platforms (i.e. incoming calls, inpatients, high priority cases, policy reviews).
Assessment of each designated case with respect to its medical elements and provide direction in order to facilitate medical due diligence and render the appropriate assistance.
Provide medically driven case direction during the daily morning handover (Transmission) process.
Determine the frequency/intensity of medical contacts and communication with Treating Doctors, patients, family members and associated TRICARE personnel
Provide medical input toward the planning and progress of operational issues relating to medical case management.
Liaise with medical and operational staff to facilitate the efficient management and direction of case work.
Receive and assess all medically related calls received from clients and beneficiaries and collect logistical, medical and collateral histories pertaining to the medical event/incident.
Provide telephonic medical assessment of beneficiaries in our region, refer to appropriate care and monitor the appropriateness of the treatment being received.
Sourcing medical referrals so that beneficiaries are referred to appropriate levels of care and the appropriate medical provider is selected.
Liaise with medical professionals for beneficiaries treated or hospitalised to ensure accurate medical assessment and information is obtained in a time bound manner.
Promote and reinforce the need for evidence-based medical decision making and advice with clear documentation of the information and source.
Review of the medical treatment received or recommended to beneficiaries to ensure it is medically appropriate, authorise cover and issue authorization under the TRICARE policy.
Ensure that all medical information released upholds all consent and confidentiality rules as per HIPPA requirements.
Focus on quality of service delivery to ensure that the highest possible levels are achieved for both the beneficiary and the client.
Engage complaints in a professional manner, resolving them wherever possible or referring them to the appropriate department or your line manager.
Assess the medical and logistical aspects of medical evacuations and repatriation, including, but not limited to, the assessment of the necessity of an evacuation and the means by which it should take place.
Ensure a high level of professionalism at all times when dealing with beneficiaries, colleagues and TRICARE.
Support medical management and TRICARE learning and development teams with the training of TRICARE staff as a buddy or mentor.
Recognise limitations and areas of self-development through reflection.
Experience Required:
Registered General Nurse Active Registration/License (SNB License)
Minimum 5 years of relevant work experience
Minimum 1 year of experience in acute care (ICU/ED) and/or primary care, Medical/Surgical, Maritime medical experience,
Previous telephone triage experience desirable
Previous experience in Clinical Case Management desirable, not essential
BCLS certification
Broad medical knowledge with clinical experience and critical thinking skillset
Computer literacy skills with experience in Word, Outlook Excel and Adobe (PDF)
Excellent customer service skills.
