TriWest Healthcare Alliance

Manage procurement processes ensuring compliance with federal regulations and lead a team of procurement specialists. | Bachelor's degree or equivalent experience, 5+ years procurement experience including 2+ years management, US citizenship, and knowledge of federal acquisition regulations. | Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen, and military family members are encouraged to apply! Job Summary Under the direction of the Director, Procurement, the Procurement Manager is responsible for ensuring procurements are conducted in accordance with internal policy, customer requirements, including the Federal Acquisition Regulation (FAR), other U.S. Government agency acquisition rules and regulations and U.S. public laws and statutes. This individual is responsible for ensuring timely and accurate processing of solicitations, evaluations of proposals, and executing awards, while assessing risk and responding to changes in demand or disruptions in the supply chain. Education & Experience Required: • Bachelor’s Degree in Procurement and Supply Chain Management, Business Administration, Finance, or related field or equivalent experience • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation • 5+ years in procurement or government contracting operations • 2+ years of management experience in procurement or government contracting operations to include managing teams, processes and systems • Proven track record in supporting complex, high-value federal contracts and supplier relationships • Detailed working knowledge of FAR and other U.S. Government agency acquisition rules and regulations and U.S. public laws and statues • Strong understanding of federal acquisition processes, including source selection, contract negotiation, and documentation compliance • Experience with successfully managing contractors through Contractor Procurement System Reviews, compliance, and risk management processes on behalf of an organization Preferred: • Master’s Degree in Procurement and Supply Chain Management, Business Administration, Finance, or related field or equivalent experience • 5+ years of experience supervising procurement operations in Federal government or prime or subcontractor environments • Certified Public Procurement Officer (CPPO), Certified Professional in Supply Management (CPSM), Certified Federal Contracts Manager (CFCM)or equivalent Key Responsibilities • Proposes and administers policies and procedures in strict accordance with applicable federal regulations, ethical standards and organizational goals. • Leads a team of Procurement Specialists who engage in procurement activities, including planning, directing, and coordinating the procurement process, such as competitive bid process, evaluations, reporting, and government audits. • Interacts frequently with TriWest’s leaders to solve business problems with the ability to anticipate and address procurement challenges while ensuring compliance with federal regulations. • Identifies and mitigate procurement risks, which includes legal, financial, and operational risks, ensuring compliance with procurement audits and external procurement system reviews. • Identifies process improvements to enhance efficiency and effectiveness. • Identifies professional development opportunities for team members to enhance skills in strategic sourcing, negotiations, and analytics. • Use procurement software to track spending, generate reports, and provide insights for decision-making. • Conducts internal monitoring on a periodic basis to ensure on-going compliance with internal procedures as well as contractual requirements. • Serves as a key liaison for government auditors and review teams. • Reviews major solicitations, conducts cost analysis and ensures compliance, identifying opportunities for improvement. • Assigns work to subordinate staff commensurate with their qualifications and existing workload. • Reviews the work of staff to ensure compliance with applicable laws, policies and procedures. • Reviews and executes contracts, purchase orders, change orders and other documents within delegated authority. • Develops and maintains a comprehensive understanding of market trends, supplier capabilities, and emerging technologies to inform procurement strategies. • Manages supplier relationships to secure best-value contracts and ensure reliable supply chains. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. 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 analysis of processes with sound judgment; has a realistic understanding of relevant issues. Technical Skills: Working knowledge of FAR and VAAR; Microsoft Office – Excel, PowerPoint, Teams, Outlook. Working Conditions Working Conditions: • Availability to work non-regular hours as required • Works within an office environment • Extensive computer work, with prolonged sitting • Periodic travel may be required Company Overview Taking Care of Our Nation’s Heroes. 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. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $122,000 - $128,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage procurement operations ensuring compliance with federal regulations and lead a team to optimize supplier relationships and contract execution. | Requires 5+ years procurement experience including 2+ years management, knowledge of FAR, US citizenship, and ability to pass DoD background check. | Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen, and military family members are encouraged to apply! Job Summary Under the direction of the Director, Procurement, the Procurement Manager is responsible for ensuring procurements are conducted in accordance with internal policy, customer requirements, including the Federal Acquisition Regulation (FAR), other U.S. Government agency acquisition rules and regulations and U.S. public laws and statutes. This individual is responsible for ensuring timely and accurate processing of solicitations, evaluations of proposals, and executing awards, while assessing risk and responding to changes in demand or disruptions in the supply chain. Education & Experience Required: • Bachelor’s Degree in Procurement and Supply Chain Management, Business Administration, Finance, or related field or equivalent experience • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation • 5+ years in procurement or government contracting operations • 2+ years of management experience in procurement or government contracting operations to include managing teams, processes and systems • Proven track record in supporting complex, high-value federal contracts and supplier relationships • Detailed working knowledge of FAR and other U.S. Government agency acquisition rules and regulations and U.S. public laws and statues • Strong understanding of federal acquisition processes, including source selection, contract negotiation, and documentation compliance • Experience with successfully managing contractors through Contractor Procurement System Reviews, compliance, and risk management processes on behalf of an organization Preferred: • Master’s Degree in Procurement and Supply Chain Management, Business Administration, Finance, or related field or equivalent experience • 5+ years of experience supervising procurement operations in Federal government or prime or subcontractor environments • Certified Public Procurement Officer (CPPO), Certified Professional in Supply Management (CPSM), Certified Federal Contracts Manager (CFCM)or equivalent Key Responsibilities • Proposes and administers policies and procedures in strict accordance with applicable federal regulations, ethical standards and organizational goals. • Leads a team of Procurement Specialists who engage in procurement activities, including planning, directing, and coordinating the procurement process, such as competitive bid process, evaluations, reporting, and government audits. • Interacts frequently with TriWest’s leaders to solve business problems with the ability to anticipate and address procurement challenges while ensuring compliance with federal regulations. • Identifies and mitigate procurement risks, which includes legal, financial, and operational risks, ensuring compliance with procurement audits and external procurement system reviews. • Identifies process improvements to enhance efficiency and effectiveness. • Identifies professional development opportunities for team members to enhance skills in strategic sourcing, negotiations, and analytics. • Use procurement software to track spending, generate reports, and provide insights for decision-making. • Conducts internal monitoring on a periodic basis to ensure on-going compliance with internal procedures as well as contractual requirements. • Serves as a key liaison for government auditors and review teams. • Reviews major solicitations, conducts cost analysis and ensures compliance, identifying opportunities for improvement. • Assigns work to subordinate staff commensurate with their qualifications and existing workload. • Reviews the work of staff to ensure compliance with applicable laws, policies and procedures. • Reviews and executes contracts, purchase orders, change orders and other documents within delegated authority. • Develops and maintains a comprehensive understanding of market trends, supplier capabilities, and emerging technologies to inform procurement strategies. • Manages supplier relationships to secure best-value contracts and ensure reliable supply chains. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. 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 analysis of processes with sound judgment; has a realistic understanding of relevant issues. Technical Skills: Working knowledge of FAR and VAAR; Microsoft Office – Excel, PowerPoint, Teams, Outlook. Working Conditions Working Conditions: • Availability to work non-regular hours as required • Works within an office environment • Extensive computer work, with prolonged sitting • Periodic travel may be required Company Overview Taking Care of Our Nation’s Heroes. 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. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $122,000 - $128,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Lead and oversee program management, product delivery, and strategic initiatives across the organization. | Requires 15+ years leadership in program management, experience with large-scale projects, strategic planning, and team leadership, preferably in healthcare or DoD environments. | Profile We offer remote work opportunities (AZ only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary The Vice President of Planning and Program Management is responsible for TriWest’s program management and product delivery activities. Oversees project, program, and implementation management, product delivery, as well as planning activities. Establishes and directs TriWest’s Program Management Office (PMO) to ensure the organization’s resources are used in a manner that aligns with TriWest’s mission and vision. Responsible for building a scalable and measurable business design organization that enables the organization to meet and exceed performance standards. Provides strategic leadership and oversight for the PMO and Product Management functions. Reporting to the Senior Vice President of Strategic Planning and Development, this role will be accountable for the results of large scale, enterprise-wide strategic and operational initiatives that extend across the business and corporate centers, and will be responsible for monitoring, tracking and reporting on projects that are being managed by other units across the business. Education & Experience Required: • Master's degree in Health Care Administration, Business Administration, or related field. • 15+ years’ progressively responsible leadership experience with a proven track record of building and leading a solution delivery function; managing complex, highly technical projects across functions and business lines; translating strategic thinking into action plans and results; building relationships with senior leaders; and presenting to executive leadership • Experience directing multiple long-term, large-scale projects, facilitating large-scale meetings, strategic planning, and operational planning • Experience leading teams of program managers, project managers, product managers, and/or business analysts • Experience with implementing and managing project work streams through both traditional (E.g. waterfall) and agile project management. • Experience with leading business design Centers of Excellence • Experience developing program status monitoring and reporting methodology and dashboard reporting instructions • Experience directing program planning, execution, and implementation • Experience directing capture management and Request for Proposal response development • Proficiency in MS Excel, Project, Visio, and PowerPoint • Strong financial knowledge Preferred • Experience with and knowledge of health plans and healthcare systems • Experience with Veterans Affairs and/or Department of Defense health care operations • Experience with Department of Defense and/or Department of Veterans Affairs contract proposal development, implementation planning/reporting, and program execution Key Responsibilities • Responsible for delivering the organization’s portfolio of projects, which include large/complex/cross-functional strategic and/or technical initiatives within the defined scope, quality, time and cost requirements. • Lead a team of project, product, and program managers on a wide range of initiatives of varying complexity. Ensure clarity of business objectives, connectivity across efforts and escalation and resolution of project risks. • Drive best practices in product management, agile methodologies, and quality assurance across the organization • Implement scalable project management and business design structures that align to industry standards (E.g. OPM3 for Project Management) • Define and establish best practices for the full lifecycle of initiatives to ensure alignment with corporate strategies and goals. Examples include project planning, initiation, resourcing, execution, monitoring, control, and completion. • Lead business planning efforts and build governance frameworks to support effective communication of project updates, changes, and dependencies. Provide timely, accurate and relevant project and portfolio reporting. • Lead and scale the Agile Project Management function, ensuring the effective application of agile methodologies (Scrum, Kanban, etc.) across development teams. • Develop and execute a comprehensive product delivery strategy aligned with the company's overall business objectives and product vision. • Lead enterprise program project portfolio efforts including short term assessments, quick hit initiatives, longer term process improvement projects, operational plans, joint TriWest/Government projects, and any other project or initiative that requires company resources. • Monitor, provide feedback, and remediate daily/weekly/monthly status of all projects in the program portfolio including joint government projects/initiatives, and pilots. • Lead operational planning meetings including initiatives and projects related to growth, performance, and innovation in addition to others. • Provide weekly status reports, cost projections, and retrospective analysis regarding benefits realization and ensure effective prioritization of features and backlog management across product lines. • Assess the cross impact of programs across the enterprise to eliminate any duplication of efforts and ensure optimal resource efficiencies. • Lead the planning, content coordination, and delivery of the annual plans mandated by the government. • Lead the planning, management and monitoring of contract implementations and modifications. • Direct the development of operational plans in accordance with established corporate goals and strategic direction. • Manage employee performance reviews and address complaints. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / 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. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. Multi-Tasking / Time Management: Prioritize and manage actions to meet changing deadlines and requirements within a high volume, high stress environment. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Knowledge of basic contracting vehicles and guidance (Government Services Administration Schedule, Federal Acquisitions Regulations); expert skill at effectively and sensitively interacting with all management levels, the Board, and the government community; networking skills with external entities; data management expertise; knowledge of relational databases; proficient with Microsoft Word, Excel, Visio, and PowerPoint. Working Conditions Working Conditions • Works non-regular hours as required • Works within a standard office environment, with moderate travel • Department of Defense security clearance may be needed Company Overview Taking Care of Our Nation’s Heroes. 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. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage healthcare data reporting and analysis to provide insights and optimize healthcare network performance. | Requires 5+ years healthcare data analysis, 3+ years managing analytics teams, and proficiency with BI tools and healthcare coding. | Profile We offer remote work opportunities in the following locations ONLY: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY US Citizenship REQUIRED: Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary 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. Education & Experience Required: • Bachelor's degree in Business Administration, Healthcare, Statistics, Information Management, CIS or related field or equivalent experience • 5+ years of data analysis and reporting experience in the health care or insurance industry • 3+ years experience leading/managing reporting and analytics teams • Advanced knowledge of Business Intelligence tools (e.g. Tableau, SSRS) • Excellent verbal and written communication skills and an ability to synthesize and present results in a clear and concise manner • Demonstrated proficiency in the use of computer systems, spreadsheet applications, and data analysis software such as SQL query language, MS Excel and MS Access Preferred • Familiar with coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue) • 3+ years working with medical, pharmacy and ancillary claims data, membership data or other healthcare data • 3+ years developing clinical measures and analyzing healthcare outcomes • 1 year of experience with advanced analytics tools (e.g. SAS, SPSS, R) • Masters degree in Business Administration, Statistics, Public Health or other applicable discipline • Experience with VA healthcare, military health services system, and private Managed Care programs Key Responsibilities • Act as an internal consultant to work across key stakeholders to gather data, perform analysis, and provide recommendations and insights to business leaders. • Utilize coding methods and guidelines (CPT, ICD, HCPCS, POS, DRG, Revenue) to conduct clinical analysis and facilitate improved health outcomes. • Execute business reporting functions, metric creation and reports that demonstrably drive operational actions and highlight wins / opportunities. • Interpret claim data using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. • Drive improvements in cost efficiency, quality of clinical care, and effectiveness of clinical programs by performing data analysis to deliver actionable insights that are backed by empirical evidence. • Develop optimization analysis to determine how well TriWest's network meets the needs of the Government based on authorization/claims patterns, discounts achieved and access to care requirements. • Collect, compile, and analyze healthcare cost and discount trends, and identify opportunities for improving/maintaining discounts based on utilization patterns. • Collaborate with others in Data Management and IT to enhance the data warehouse to include translating technical and functional requirements into meaningful information and improve healthcare reporting capability. • Train department staff on healthcare data querying, terminology, integrity, standards, and procedures. • Coach and mentor staff toward operational excellence and skill development. • Work with management to understand and interpret the impact of decisions made by retrieving and analyzing claims costs, authorizations and/or other relevant data. Work closely with various groups in the assembling of data, development and application of quantitative analysis and mathematical models for internal and regulatory reporting requirements. • Support Government reporting requirements, management and the medical management system by managing automated reports. • Develop methods for consistency and validity and review the accuracy of data and reports. Determine the best approach for presenting data in an efficient and beneficial manner. • Preparation of annual performance evaluations and development plans for assigned staff. • Perform other duties as assigned. • Regular and reliable attendance is required. Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. Leadership: Successfully manage different styles of employees; Provide clear direction and effective coaching. 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 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: Strong knowledge of Microsoft Excel, Access, Preferred strong knowledge of Crystal Reports, SQL Reporting Services, and other query software; Knowledge of relational databases; Working knowledge of medical management systems; Working knowledge of referral and authorization systems; Working knowledge of healthcare; Working knowledge of medical coding, HIPAA regulations, claims processing, and healthcare reimbursement systems Working Conditions Working Conditions • Works within a standard office environment with minimal travel o Extensive computer work with prolonged sitting Company Overview Taking Care of Our Nation’s Heroes. 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. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $125,000 - $134,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage and coordinate corrective action plans including scheduling, documentation, stakeholder engagement, and performance tracking for government healthcare programs. | Requires 5+ years program/project management experience, strong organizational and analytical skills, US citizenship, and ability to pass DoD background check. | Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary The Program Manager, Strategic Performance Excellence supports the development and execution of Corrective Action Plans (CAPs) in response to government-issued Corrective Action Requests (CARs) across the TRICARE (T-5) and Community Care Network (CCN) programs. This role operates as part of a two-person pod with a Senior Delivery Lead and serves as both a program/project manager and business analyst. The Program Manager is responsible for schedule management, task coordination, documentation development, stakeholder coordination, performance tracking, and overall operational orchestration of assigned CAPs. The position supports the management of 2–4 CAPs concurrently during execution phases while assisting in intensive initiation and root cause analysis activities for newly issued CARs. This role requires strong organizational discipline, analytical capability, and executive-level professionalism in a high-visibility, deadline-driven environment. In addition, this role partners with the Quality Performance Improvement team to integrate preventive insights and leading indicators from Quality Improvement Plans into project plans, timelines, and reporting to help mitigate risks before they escalate. Education & Experience Required: • Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Industrial Engineering, or related field or equivalent experience • U.S. Citizen • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation • 5+ years of experience in program management, project management, quality improvement, healthcare operations, compliance, or performance management • Demonstrated experience managing complex, cross-functional workstreams Preferred • Experience supporting corrective action initiatives, audit responses, or regulatory remediation efforts • Project Management Professional (PMP) certification • Lean or Six Sigma certification Key Responsibilities • Program & Schedule Management • Develop and maintain integrated CAP work plans, timelines, milestones, and deliverables. • Track corrective action tasks, dependencies, risks, and mitigation strategies. • Ensure timely completion of milestones in alignment with government submission deadlines. • Maintain structured documentation of all CAP artifacts, including RCA documentation, action plans, evidence logs, and reporting materials. • Proactively identify schedule risks and escalate to the Senior Delivery Lead. Documentation & Deliverable Development • Draft and maintain CAP documentation, including: o Root cause analysis summaries o Corrective action implementation plans o Milestone tracking logs o Status reporting decks and updates • Partner with the Strategic Communications Specialist to ensure final deliverables are polished and executive-ready. • Maintain version control and documentation governance standards. • Ensure documentation aligns with internal policies and contractual expectations. • Stakeholder Coordination & Engagement • Coordinate working sessions, stakeholder interviews, and cross-functional meetings. • Capture meeting notes, action items, and decisions. • Track stakeholder commitments and follow-ups. • Support engagement across Operations, Clinical, Network, IT, Compliance, and Quality teams. • Assist in preparation for executive and government-facing presentations. Data Analysis & Reporting • Gather and validate quantitative performance data related to corrective actions. • Support development of dashboards and performance reporting mechanisms. • Conduct analysis to assess impact of corrective actions against defined metrics. • Prepare qualitative and quantitative status reports for leadership review. • Monitor performance trends and support reassessment efforts when outcomes do not align with expected improvement. • Risk & Issue Management • Maintain CAP risk and issue logs. • Track mitigation actions and resolution status. • Ensure documentation of control improvements and sustainability mechanisms. • Support readiness activities for government follow-up or validation reviews. Competencies Communication / People Skills: Strong written documentation and structured communication capability. High Intensity Environment: Ability to operate effectively in high-pressure, deadline-driven environments. Organizational Skills: Experience developing detailed work plans and tracking execution. Strong attention to detail and documentation discipline. Team-Building / Team Player: Strong interpersonal skills and ability to coordinate across stakeholder groups. Technical Skills: Program and project management; business analysis; risk tracking & mitigation. Working Conditions Working Conditions • Works in a standard office environment • Must be able to work non-regular hours and extended shifts as required to meet government-mandated deadlines • High-intensity work environment with tight turnaround timelines • Regular and reliable attendance is required Company Overview Taking Care of Our Nation’s Heroes. 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. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $112,000 to $119,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage AI initiative lifecycle, enforce governance, and lead cross-functional teams in a regulated healthcare environment. | Requires 8+ years program/product management including 3+ years in AI/ML, AI governance framework experience, and leadership in complex regulated settings. | Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary The Manager, AI Programs & Governance serves as the primary bridge between business operations and technical engineering, leading the intake, prioritization, and ROI validation of all AI initiatives across TriWest Healthcare Alliance. Reporting to the Director of AI and Automation, this role operates with significant latitude for independent judgment and is accountable for managing the full AI initiative lifecycle — from initial intake and governance approval through post-deployment value realization. The scope spans the enterprise, requiring coordination across clinical operations, finance, legal, security, and technical engineering teams in a regulated healthcare and federal contracting environment where decisions carry material risk and compliance implications. The complexity of this role stems from the need to simultaneously manage a dynamic portfolio of high-visibility AI initiatives, enforce governance standards aligned with NIST AI Risk Management Frameworks and HIPAA requirements, and translate probabilistic AI capabilities into defensible business cases for non-technical executive stakeholders. The Manager owns the AI Governance Committee and is responsible for ensuring that all initiatives meet TriWest’s acceptable use policies, risk thresholds, and federal compliance obligations before and after deployment. This position directly manages the Sr. Process & AI Business Analyst and provides indirect leadership to consulting staff executing on current AI requests for proposals, with the expectation that the team will expand as the AI portfolio grows. Education & Experience Required: • Bachelor's degree in Computer Science, Business Administration, or related field, or equivalent work experience. • U.S. Citizen. • Must be able to receive a favorable interim and adjudicated final Department of Defense (DoD) background investigation. • 8 or more years of experience in Program Management or Product Management, with at least 3 years specifically within a Data Science or AI/ML environment. • 3 or more years of direct experience managing the AI/ML Development Lifecycle, including data preparation, model training and tuning, and deployment. • Experience implementing AI Governance Frameworks such as NIST AI RMF or ISO 42001 within the healthcare industry. • Proven track record managing AI risk and compliance related to HIPAA, PHI, and PII data privacy standards. • Experience translating technical AI capabilities such as RAG or LLM architectures into actionable business value for non-technical healthcare stakeholders. • Demonstrated success conducting process audits and establishing mitigation strategies for operational algorithms. • Leadership experience managing cross-functional gate approval processes for complex, multi-stakeholder technology deployments. Preferred • Master's degree in Business Administration (MBA) or Technical Management. • Certifications in AI Ethics, Data Privacy (CIPP), or Project Management (PMP/Agile). • Experience working in large-scale or highly regulated environments such as healthcare, finance, or government. Key Responsibilities • Manage the AI initiative intake pipeline, triaging requests against strategic value, technical feasibility, and organizational risk to ensure the enterprise solves the right problems with the right level of AI investment. • Define and enforce acceptable use policies for AI and serve as lead for the AI Governance Committee, ensuring all initiatives align with NIST AI Risk Management Frameworks, HIPAA, and TriWest compliance standards. • Partner with Finance and Operations to define baseline KPIs pre-deployment and validate actual hard and soft savings post-deployment, producing ROI validation reports for executive leadership. • Act as product owner for the enterprise AI portfolio, translating business requirements into clear user stories and functional specifications for the technical engineering team. • Lead human-in-the-loop training strategies and drive implementation strategy for pilot and full-scale AI deployments, ensuring operational teams are prepared to adopt new automated workflows. • Manage the performance, development, and workload of direct and indirect reports, including the Sr. Process & AI Business Analyst and consulting staff assigned to current AI initiatives. • Serve as primary liaison between business operations leadership and the Principal AI Solution Architect, ensuring technical solutions remain anchored to validated business needs. • Monitor deployed AI solutions for ongoing compliance, performance drift, and value realization, escalating risks to the Director of AI and Automation as appropriate. • Regular and reliable attendance is required. Competencies Communication / People Skills: Skilled at translating complex AI and data science concepts into clear, executive-ready business language. Able to engage credibly with clinical operations leaders, finance partners, legal and compliance teams, and technical engineers simultaneously, adapting communication style to each audience. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Operates effectively in a nascent, rapidly changing AI function where priorities, tools, and regulatory guidance shift frequently. Maintains composure and decisiveness under ambiguity, adjusting program plans without losing sight of governance obligations or delivery commitments. Creativity / Innovation: Approaches enterprise AI governance not as a compliance exercise but as a value-creation function. Continuously evaluates emerging AI frameworks, tools, and industry practices to refine TriWest's AI intake and governance model as the field evolves. Delegation Skills: Provides clear scope, priorities, and success criteria to direct reports and consulting staff. Establishes accountability structures that allow the team to operate with appropriate autonomy while maintaining governance oversight and program visibility. High Intensity Environment: Performs effectively under the sustained pressure of managing high-visibility, enterprise-wide AI initiatives with significant compliance, financial, and operational consequences. Maintains accuracy and sound judgment when timelines are compressed and stakeholder expectations are high. Leadership: Demonstrated ability to lead cross-functional initiatives in a matrixed organization, managing direct reports and consulting staff toward clear program outcomes. Provides direction, removes obstacles, and holds teams accountable to delivery timelines and governance standards in a high-visibility, high-stakes AI environment. Multi-Tasking / Time Management: Prioritizes and sequences program activities across the intake pipeline, governance committee, deployment tracking, and team management responsibilities simultaneously, managing competing demands without compromising the quality of governance decisions. Organizational Skills: Manages a dynamic portfolio of concurrent AI initiatives across multiple business units, each at different stages of the lifecycle. Maintains program documentation, governance records, and ROI tracking with the discipline required for federal audit readiness. Problem Solving / Analysis: Ability to evaluate complex, ambiguous AI initiative requests against strategic value, technical feasibility, and organizational risk. Applies structured analytical frameworks to prioritize the portfolio, identify gaps in business cases, and recommend mitigation strategies for algorithmic risk. Technical Skills: Strong understanding of Generative AI architectures including large language models and transformers, Retrieval-Augmented Generation, and the distinction between deterministic automation such as RPA and probabilistic AI. Sufficient technical fluency to evaluate solution proposals, assess risk, and engage credibly with engineering teams without requiring deep hands-on development experience. Working Conditions Working Conditions • Works within a standard office environment; remote work eligible per TriWest telecommuting policy with periodic office attendance as required. • Extensive computer work with long periods of sitting. • May work non-standard hours to support AI initiative deployments, governance committee meetings, or executive review cycles. • Regular and reliable attendance is required. Company Overview Taking Care of Our Nation’s Heroes. 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. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $155,000 - $173,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Analyze and assess provider network adequacy and capacity, develop reports and metrics, and support network gap management. | Bachelor's degree or equivalent experience, 2+ years in healthcare data analysis, intermediate to advanced Excel skills, and experience with network adequacy reporting. | Profile We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Provides and develops requested reports, analysis and metrics to assess provider network adequacy. Assesses demands for geographical services for all specialty types. Plays a key role in the development and maintenance of the demand capacity tool that is used to help analyze network accessibility/capacity and for managing requests for additional providers to address gaps. Provides analytical support and supports internal and external customers with network assessments to address deficiencies. Supports the production, reviews and actions necessary from mandated program reports. Produces outcome and program reports and suggests strategies and recommendations for improvement. Education & Experience Required: • Bachelor's degree in Business, Health Care Administration, Data Analysis, or equivalent work experience • 2+ years working in health care environment dealing with developing analysis • Intermediate to advanced Excel skills • Experience with research, data analysis and reporting, and process improvement • Experience identifying, implementing and monitoring network adequacy reporting Preferred • Experience in analysis of provider network access and adequacy Key Responsibilities • Performs analysis to assess accessibility and capacity of provider network • Supports others in assessments • Develops, manages and address provider network gaps • Maintains and improves demand capacity and network adequacy tools • Identifies, designs, and conducts network adequacy/capacity assessments • Monitors program metrics and resulting outcome reports. Writes and produces professional quality internal and external position papers, reports and plans. • Supports the review and submission of mandated reports to the government • Supports responses to internal and external ad hoc requests • Compiles and analyzes network adequacy data to prepare reports for submission • Performs other duties as assigned • Regular and reliable attendance is required Competencies Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Information 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 analysis of processes with sound judgment; has a realistic understanding of relevant issues. Technical Skills: Proficient in Excel, Word, PowerPoint and Visio; expertise in preparing written communications and presentations; knowledge of performance measurement and quality improvement tools and disease management concepts. Prefer experience with Tableau and/or PowerBI. Working Conditions Working Conditions • Works within a standard office environment, with minimal travel required • Extensive computer work with long periods of sitting TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $80,000 to $89,000 per year. Company Overview Taking Care of Our Nation’s Heroes. 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. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Provide training and daily direction to claims customer service representatives, resolve complex claims issues, collaborate with internal and external stakeholders, and ensure compliance with HIPAA and department productivity goals. | High school diploma or GED, 1 year call center experience, 2 years claims resolution or billing experience, proficiency with Microsoft Office, strong communication skills, and knowledge of medical terminology. | Profile We offer remote work opportunities (AK, AR, AZ, CA, *CO, FL, *HI, IA, ID, *IL, KS, LA, MD, *MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, *WA, WI & WY only). Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary As part of the claims escalation team, provides training, resolution and daily direction to the Claim Customer Service Representatives. Supports team by researching claims data, claim system, and authorizations to resolve provider claims questions. Interacts with outside entities and internal departments to resolve claims inquiries. Utilizes multiple software applications, applies business rules, and knowledge of provider or authorizations to resolve provider claims questions. Works under timelines while meeting accuracy and production goals. Education & Experience Required: • High School diploma or G.E.D. • One year experience working in a call center • Proficient with Microsoft Outlook, Word and Excel • Strong Knowledge of medical terminology • 2 years claims resolution, billing experience or demonstrated success as a TriWest Claims Customer Service Representative • Strong written and verbal communication skills Preferred • Associates degree in healthcare or related field Key Responsibilities • Reviews, analyzes and directs resolution of complex claims issues. • Interfaces with Claims and CCOPs leaders, CSRs, other internal departments, VA and vendors. • Serves as a Subject Matter Expert to Claims Customer Service Representatives and other internal departments. • Investigates recurring problems, identifying process improvements and reporting findings to leadership. • Tracks daily questions and resolution trends. • Documents all communications involving staff, Veteran, and provider contacts. • Reviews large amounts of complex information from multiple sources, including validating appropriate data on claim. • Collaborates with Claims sub-contractor to build or update authorization and provider records. • Participates in training documentation creation and updates. • Manages multiple task lists in accordance within directed timelines. • Maintains updated knowledge of software applications, Claims trends, and Claim CSRs’ procedures and processes. • Complies with HIPAA regulations to protect privacy of health information. • Consistently meets department productivity and performance metrics. • Manages and prioritizes daily workflow queues to ensure timeliness standards are met. • Identifies and reports any potential quality or fraud issues to management. • Practices professional and concise communication in writing and by phone. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; Commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. 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 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 CCN policies, processes, and procedures, knowledge of call management methodology. Working Conditions Working Conditions • Ability to cover any work shift with no travel • Works within a standard office environment • Extensive computer work with prolonged sitting and wearing of headset • VA-approved security clearance may be required Company Overview Taking Care of Our Nation’s Heroes. 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. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Generous paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time • Annual base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $47,000 - $60,000 depending on experience* Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage clinical operations compliance with URAC and DoD standards, oversee policy development, lead accreditation efforts, and supervise clinical audit programs. | Must have RN or LCSW license, 5+ years in healthcare quality/compliance management, 5+ years managing staff and programs, US citizenship, and ability to pass DoD background check. | Profile This is a hybrid position, mostly remote, but onsite in Phoenix, AZ occasionally. Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply! Job Summary Manages Clinical Operations Regulatory Compliance, policy development, and program execution. This position reports to the VP Clinical Operations and coordinates with clinical operations leaders to assure URAC and T-5 Contract compliance. This position will have the responsibility to develop, implement and provide oversight of TriWest Clinical compliance program, ensuring adherence to all applicable federal, state and local regulations, as well as accreditation standards. This role focuses on maintaining the integrity of the clinical operations through robust policies, procedures, auditing and effective governance oversight. Education & Experience Required: • Current, unrestricted Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) license recognized as valid by the applicable state licensure board where the position is located • Bachelor's Degree in Nursing, Social Work, Health Care Administration or other health related field • U.S. Citizen • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation • 5 years’ experience quality, compliance or related field in healthcare • 5 years’ experience in management of staff and programs Preferred • URAC (Utilization Review Accreditation Commission) recognized Case Manager Certification Master's Degree in Nursing or related field • Previous experience leading and managing case management or utilization management Veterans Healthcare or TRICARE Program experience • Demonstrated experience in performing analysis of utilization and quality data and with policy development and technical writing Key Responsibilities • Provides leadership to ensure compliance with URAC standards. • Directs all aspects of URAC accreditation for relevant clinical programs. • Supervises accreditation coordinators and collaborates subject matter experts related to accreditation compliance. Organizes and coordinates workflows with immediate team and related teams. Provides direction, coaching, performance management and issues resolution to team. • Ensures ongoing compliance with all URAC standards, including continuous monitoring, gap analysis, implementation. • Ensures comprehensive documentation for URAC accreditation, including policies, procedures, training records, and evidence of compliance. • Provides oversight of Clinical Operations Policy and Procedure Development and management. • Develops, reviews, revises and maintains all clinical operations policies and procedures to ensure compliance with regulatory requirements, URAC and internal best practice. • Establishes a systematic process for policy review cycles, approvals, communication and version control. • Designs, implements, and manages a comprehensive clinical auditing program to assess adherence to policies, procedures, regulatory requirements, and URAC standards. • Conducts routine and ad hoc audits of clinical operations departments, provider credentialling, appeals and grievances related to clinical operations, and special oversight programs related to quality of care delivered in the network (e.g. prescription monitoring and TRICARE Quality Monitoring Contract or TQMC). • Provides oversight and coordination of the clinical audit programs and performs analyses to measure program impact and identify opportunities to improve the effectiveness of the program to meet performance targets. • Performs annual and ongoing evaluation of the Clinical programs to ensure adherence to URAC standards, TRICARE policy, contractual requirements, HIPAA privacy and nationally recognized practice. • Develops training programs, training documents, and flow diagrams to address targeted operational issues related to compliance and audit. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Excel, PowerPoint, Outlook, TriWest Intranet, the Internet, and department software applications. Delegation Skills: Provide clear performance expectations for projects and ensure adequate access to resources for completion. Independent Thinking / Self-Initiative: Critical thinker with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. Leadership: Successfully manage different styles of employees; provide clear direction and effective coaching. 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 analysis of processes with sound judgment; has a realistic understanding of relevant issues. Ability to plan, implement, and monitor program effectiveness and efficiency. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of TRICARE programs and benefits, URAC national best-practice standards; health care delivery; clinical quality assurance program metrics, utilization management, case management, managed care concepts, management reporting tools, and medical management systems; ability to perform critical, in-depth analysis of medical records for appropriateness and level-of-care determinations. Working Conditions • Works non-regular hours, as required • Works hybrid, remotely and in office, with 10% travel • Extensive computer work with prolonged sitting • Department of Defense security clearance required Company Overview Taking Care of Our Nation’s Heroes. 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. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $109,000 to $139,000 per year. Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

Manage escalated customer service inquiries via chat, phone, and electronic messaging, provide subject matter expertise on TRICARE benefits, support leadership with data and training, and ensure customer satisfaction in a fast-paced environment. | High school diploma or GED, U.S. citizenship, call center or TriWest customer service experience, ability to pass DoD background check, and knowledge of customer service processes. | Profile • Must Reside in Alaska** Job Summary Manages escalated and complex scenarios through chats, telephonic interaction, and electronic messaging from Customer Service Representatives, internal TriWest departments, and Defense Health Agency personnel. Provides back-up phone and payment support during periods of high inbound call volume and/or high task inventory. Works in a detailed, multi-tasked and fast-paced production environment. Education & Experience Required: • High School diploma or G.E.D. • U.S. Citizen • Must be able to receive a favorable interim and final Department of Defense (DoD) background investigation • At least one year of TriWest customer service experience or previous call center team lead experience within the last 3 years Preferred • Health plan experience in a customer service setting • Associate’s degree or health care related certification Key Responsibilities • Assigned to the Navigator call queue, provides subject matter expertise (SME) by correctly answering telephonic, electronic and chat inquiries regarding operational processes and complex customer service inquiries. • Develops and maintains TRICARE benefit knowledge, processes and procedures. Attends and masters applicable training. • Handles escalated inquiries from staff and other departments ensuring a quick and accurate resolution to maintain internal and external customer satisfaction. • Connects with other department designated SMEs as needed to ensure first call resolution. • During times of excessive inbound call volumes and/or task inventory, takes inbound or makes outbound calls depending on call volume needs. • Takes direct inbound calls from specialized populations such as BEPP, BCAC, DCAO, MMSO, DHA to resolve caller concerns or questions. • Tracks and analyzes escalation patterns to identify common issues, knowledge gaps, or process inefficiencies, sharing findings with management to drive improvements in training, policies and workflows. • Partners with the Training, Knowledge Management, as well as other departments to resolve the identified knowledge gaps by supporting leaders with tools and information to resolve concerns. • Maintains updated knowledge of software applications, on-line systems, Customer Service Representative procedures and processes. • Assists Customer Service Representative leaders in tracking learning opportunities and Navigator Support Desk utilization. • Supports the leadership teams through data and program knowledge. Coaches to correct responses but does not performance coach/lead. • Documents all communications involving customer contacts. • Coordinates complete resolution of service issues by interfacing with the TriWest Complaints & Grievance Specialists, Military and Veteran’s Services (MVS), and DHA, other departments when requested. • Consistently contributes to the achievement of department productivity and performance metrics. • Performs other duties as assigned. • Regular and reliable attendance is required. Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to unique styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources. Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. 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 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 TriWest policies, processes, and procedures, knowledge of call management methodology. Working Conditions Working Conditions • Ability to cover any work shift with no travel • Works within a standard office or virtual environment • Extensive computer work with prolonged sitting and wearing of headset • Security clearance required Company Overview Taking Care of Our Nation’s Heroes. 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. DoD Statement Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Benefits We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: • Medical, Dental and Vision Coverage • Generous paid time off • 401(k) Retirement Savings Plan (with matching) • Short-term and long-term disability, basic life, and accidental death and dismemberment insurance • Tuition reimbursement • Paid volunteer time • Annual base salary for Colorado, Hawaii, Illinois, Minnesota, Washington D.C. and Washington State residents: $43,000 - $55,000 depending on experience* Equal Employment Opportunity TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that cultivates and supports diversity at every organizational level, including hiring and retaining a diverse workforce, and we highly encourages candidates from all backgrounds to apply. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.