Regional Senior TRICARE Community Liaison

** Become a part of our caring community*
* The Regional Senior TRICARE Community Liaison (TCL) is an important Humana Military representative committed to operational excellence, consistency, and accountability in the administration of TRICARE services within a defined territory in the East Region. You will provide expert guidance to nationally contracted healthcare providers and support facilities who have footprints across both East and West Regions.

The primary focus of the  
** Regional Senior TCL
** is to develop and sustain strong, collaborative relationships with all National Health System providers in the East Region. You will be cover all National contracted providers and large health systems regardless of location or type of care provided. Through clear and concise written and verbal communication, the Regional Senior TCL ensures provider understanding of the TRICARE health plan, TRICARE Policy and Regulations and how to navigate the Military Health System.

The Regional Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries, complicated problems and concerns raised by providers. This position upholds rigorous operational standards and ensuring consistent, high-quality delivery of TRICARE services. You will support customer service, conduct outreach, maintain network adequacy and access to care. You will manage provider relations and education, and ensure effective provider management within the assigned area.

You will lead the review of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel, ensuring a resolution through professionalism and integrity.

Additional responsibilities involve supporting the implementation of Alternative Payment Methodologies and Demonstration Pilots that advance value-based care initiatives. You will establish and maintain productive relationships and clear communication with all stakeholders, ensuring accountability and excellence in every interaction.

** KEY

ACCOUNTABILITIES *
* ** 30% Network Adequacy, Provider Management, and Access to Care*
* Maintain and assess network adequacy, ensure access to care, and manage provider relations and education within the assigned territory. Support ongoing evaluation of provider capacity and address network gaps, ensuring consistency and accountability in network performance.

** 25% Resolution of TRICARE Inquiries and Issues*
* Lead the review, investigation, and resolution of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel. Ensure all cases are managed with accuracy and in compliance with established standards.

** 20% Customer Service and Stakeholder Outreach*
* Deliver expert guidance and support to TRICARE beneficiaries, Medical Treatment Facility staff, government officials, and civilian healthcare providers. Conduct outreach activities to educate and engage stakeholders, upholding rigorous operational standards and consistent service delivery.

** 15% Relationship Management and Communication*
* Establish, foster, and maintain productive relationships with all TRICARE stakeholders. Ensure clear, consistent, and professional communication to promote operational excellence and accountability.

** 5% Support for Value-Based Care and Program Innovation*
* Contribute to the implementation of Alternative Payment Methodologies and Demonstration Pilots that advance value-based care initiatives, ensuring accuracy and accountability in all program activities.

** 5% Administrative and Compliance Tasks*
* Complete required documentation, transaction processing, and reporting accurately and in a timely manner, supporting compliance and data integrity.

** _This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives._*
* ** Use your skills to make an impact*
* ** Required Qualifications*
* + 2 or more years of experience in TRICARE

+ Experience in healthcare provider relations, provider management, provider contract negotiations or any experience working with healthcare providers

+ Experience in customer…