Job Description

Description:Job Duties and Responsibilities:\xc2\xb7 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).\xc2\xb7 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).\xc2\xb7 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.\xc2\xb7 Provide medically driven case direction during the daily morning handover (Transmission) process.\xc2\xb7 Determine the frequency/intensity of medical contacts and communication with Treating Doctors, patients, family members and associated TRICARE personnel\xc2\xb7 Provide medical input toward the planning and progress of operational issues relating to medical case management.\xc2\xb7 Liaise with medical and operational staff to facilitate the efficient management and direction of case work.\xc2\xb7 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.\xc2\xb7 Provide telephonic medical assessment of beneficiaries in our region, refer to appropriate care and monitor the appropriateness of the treatment being received.\xc2\xb7 Sourcing medical referrals so that beneficiaries are referred to appropriate levels of care and the appropriate medical provider is selected.\xc2\xb7 Liaise with medical professionals for beneficiaries treated or hospitalised to ensure accurate medical assessment and information is obtained in a time bound manner.\xc2\xb7 Promote and reinforce the need for evidence-based medical decision making and advice with clear documentation of the information and source.\xc2\xb7 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.\xc2\xb7 Ensure that all medical information released upholds all consent and confidentiality rules as per HIPPA requirements.\xc2\xb7 Focus on quality of service delivery to ensure that the highest possible levels are achieved for both the beneficiary and the client.\xc2\xb7 Engage complaints in a professional manner, resolving them wherever possible or referring them to the appropriate department or your line manager.\xc2\xb7 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.\xc2\xb7 Ensure a high level of professionalism at all times when dealing with beneficiaries, colleagues and TRICARE.\xc2\xb7 Support medical management and TRICARE learning and development teams with the training of TRICARE staff as a buddy or mentor.\xc2\xb7 Recognise limitations and areas of self-development through reflection.Experience Required:

• 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
• Registered General Nurse Active Registration/License (SNB License)
• 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.

International SOS