TRICARE Coordinating Nurse

International SOS provides comprehensive healthcare management to beneficiaries enrolled in the TRICARE Overseas Program (TOP). This role will require close interface and regular communication with TRICARE, our client, and with their beneficiaries who are enrolled in each region. The TRICARE Coordinating Nurse will be responsible for the delivery of professional and effective medical assistance services for TRICARE beneficiaries in compliance with TRICARE guidelines and TOP Contract specifications and expectations, maintaining International SOS highest standards of excellence within the respective regional contact centres. The TRICARE Coordinating Nurse will work closely with the Regional Medical and Operations teams. Ensure a high level of professionalism at all times when dealing with beneficiaries, colleagues, and TRICARE. Telephone Triage beneficiaries to assess and direct the standards of care they require. Undertake policy reviews for requested healthcare services, issue authorisations and denials. Perform assessments on standards of care tailored to each specific location and medical situation, utilizing all available resources. Provide comprehensive medical advice and recommendations according to each individual medical situation. Medically monitor and determine the frequency/intensity of medical contacts and communication with medical professionals and, beneficiaries Communicate with healthcare providers and medical professionals in the region to assess international standards of care being provided to beneficiaries. Demonstrate proficiency in utilizing the Electronic Health Record and communicating medical information regarding beneficiary’s clinical status to the client in a confidential and time bound manner while delivering appropriate medical management recommendations verbally and/or in writing to the TRICARE Area Office. Ensure optimal quality case coordination and service delivery. Responsible for medical due diligence, case direction and medical related tasks with respect to all medical assistance cases across the TRICARE platforms (i.e., incoming calls, inpatients, high priority cases, policy reviews) and appropriately escalating to the Medical Director as indicated. Promote and reinforce the need for evidence-based medical decision making. 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. Manage complaints in a professional manner, resolving them wherever possible or escalating 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. Support medical management and TRICARE learning and development teams with the training of TRICARE staff as a buddy or mentor. Provide Global Medical Support for each Regional Contact Centres (TRICARE Philadelphia (TPL), TRICARE London (TLN), TRICARE Singapore (TSN)) as required. Other duties as assigned Required Skills and Knowledge Previous experience in clinical case management desirable Previous telephone triage experience desirable Broad medical knowledge and experience in one or more or of the following areas, and a critical thinking skillset: Primary Care / General Medical / Surgical Acute care (ICU/ED) Cruise ship nursing Computer literacy skills Excellent customer service skills. Required Education/Certification: Current and unrestricted Nursing license from a ny US State or US Territory Associate’s or Bachelor’s degree in nursing is required from an Accredited nursing program. Required Qualifications: This position does require someone who can obtain a Tier 1 background investigation for a position of trust after being offered a position and maintaining after starting with International SOS. International SOS will facilitate after hire. Schedule : 4 days 10 hour shifts or 5 days 8 hour shifts Employment Type: Full Time Bonus/Commission: No