Licensed Practical Nurse (LPN) - Robins AFB, GA

Reef Systems has an immediate need for a Licensed Practical Nurse (LPN) to support the Air Force medical Service (AFMS)

mission at the Referral Management Center (RMC) located at Robins AFB, GA. This is a full-time, on-site position.

DESCRIPTION OF SERVICES :

Background :

The Air Force Medical Service (AFMS) operates and manages a worldwide healthcare system to deliver medical service for

more than 2.63 million eligible beneficiaries. Beneficiaries include active duty, family members and retirees, during both

peacetime and wartime. The AFMS responds to a full spectrum of anticipated health requirements and provides an

integrated healthcare system from forward deployed locations through definitive care with an emphasis on prevention of

illness and injury. Each referral is coordinated through a process called Referral Management (RM). When specialty care is

referred, the Referral Management Center (RMC) is responsible for advising the patient of their benefit and working with

the referring provider and the Managed Care Support Contractor (MCSC) to ensure that the referral is accurate. The RMC

is also responsible for coordinating the referral with the specialty office, facilitating the recapture of Medical Treatment

Facility (MTF) direct care capabilities, tracking the referral to closure, and returning all results of treatment to the patient's

medical record. The number of referrals in a MTF varies depending on the patient population, illness severity, local

networks, and referral patterns.

Scope :

The Contractor shall support the AFMS' mission of staffing and managing RMCs at the MTFs, serving as the one-stop shop

for all referrals from the initiation of a referral to receipt of a clear, legible, Health Insurance Portability and Accountability

Act (HIPAA) (Appendix D) compliant report is returned to the MTF. The RMC serves as the central clearing house for

providers and patients needing information or help with referrals. RM is a critical program within DoD and the AFMS,

supporting the patient-centered medical home model and optimizing the MTF's clinical specialty capabilities and

expeditionary medicine currency platforms.

SUMMARY OF REQUIREMENTS

Referral Management Center (RMC) Operations :

• Operate the RMC at the MTFs listed within Appendix A. Support RMC operations and provide referral

management services to patients during normal MTF business hours (as specified in paragraph 4) for telephonic,

electronic, and in person access.

Composite Health Care Suite (CHCS), MCSC referral systems, Armed Forces Health Longitudinal Technology

Application (AHLTA), Health Artifact Imaging & Management System (HAIMS), and Referral Management System

(RMS) Integrated Clinical Database-B (ICD-B) programs.

Care (ATC) standards and RMC Business Rules as outlined in Air Force Instruction AFI44-176 and in the AFMS

Referral Management Center Guide - version 9.0, Attachment 1 of the PWS.

Manual, the RMC business rules, and other current Government policies, regulations, and memorandums.

patient for their specialty care appointment and / or procedure.

The Contractor will utilize education opportunities during training venues to include, but not limited to,

provider / nurse orientation briefings and Professional Staff (ProStaff) meetings.

Management (PCM) team, as appropriate, of any patient that may benefit from or may require care

management / coordination.

MTF / MCSC Memorandums of Understanding. Utilize these to maximize recapture initiatives and enhancements.

Referral Review / Appointing Function :

TRICARE Operations Manual, Chapter 8, Section 5), covered TRICARE benefit and required tests and pre-work.

Coordinate with referring providers in cases where additional referral information is required.

demographic and other pertinent information through the appropriate medical systems and software programs.

Obtain current and accurate contact information (i.e., cell / home phone numbers, and address).

System (ODCS) (ex : other nearby MTF) using CHCS booking procedures, ATC standards, and established clinic

capability / booking protocols as outlined in AFI 44-176 and in the AFMS Referral Management Guide. If there are

no MTF or ODCS referral appointments within ATC standards, the RMC shall defer the referral to the network

through the MCSC. The RMC shall transmit the referral though the RMS to the MCSC.

(capability) listings and information systems that link the referral to the appointment with the ATC category and

standard.

ALTHA. Enter ROFR-type referrals into CHCS for review and appointments.

amended).

receipt.

the referring purchased care provider within ten (10) business days of the kept specialty encounter.

staff shall assist with appointing / activating referrals and providing customer support to patients as outlined in the

latest AFMS RMC Business Rules.

instructions and tests required prior to appointment.

provider, location, time, and day of referral appointments or request the patient to call back for appointment

information if patient not provided appointment prior to leaving the MTF. Include care episode information for

the referral provider as to where to return referral results.

medical information (e.g. lab reports, x-rays, previous encounter notes, etc.) to provide to the purchased care

specialist as requested / clinically required. The RMC can assist the PCM / team by faxing the documents to the

specialist's office. For STAT / ASAP referrals, the ordering provider / team is responsible for obtaining and sending

the requested information to the specialist.

by MTFs second level reviewer or MCSC. Reschedule or instruct patient of other health care options within two (2)

business days of notification of referral being invalid or disapproved by the second level reviewer.

additional systems, as outlined in the latest AFMS RMC business rules.

messages to the PCM team accordingly.

appropriate provider / team.

resubmission.

Referral Tracking Function :

from MTF, ODCS, network, and non-network providers. When follow-up results are received from specialists,

ensure they are sent to the referring provider or PCM.

CLRs within (180) calendar days, the Contractor is responsible for researching (chasing) and expeditiously

retrieving CLRs as outlined in the latest AFMS RMC business rules.

from consulted provider / specialist and return CLR results to the referring provider or PCM within three (3)

business days of receipt from the consulted provider / specialist as outlined in the TRICARE Operations Manual and

AFI 44-176 Attachment 2, RMC business rules.

RMC business rules.

specialty care appointment for the referring provider / team's action.

to be tracked and closed.

as determined by the latest AFMS RM Business rules, local MTF policies and procedures, as well as any regulatory

guidance (ex : AAAHC, TJC, NCQA, etc.) currently in effect. Accuracies shall be completed within three (3) business

days. Utilize information to maximize recapture initiatives / enhancements.

Heath Benefits Function :

outlined by their TRICARE enrollment and / or DEER status.

TRICARE benefit for approval.

Medical Evaluation Board issues as outlined in AFI 41- 210, Tricare Operations and Patient Administration

Functions, and AFI 36-3212, Physical Evaluation for Retention, Retirement, Separation (in conjunction with MTF

Physical Evaluation Board Liaison Officer and MTF PRP monitor). Verify appropriate paperwork is on file prior to

authorization.

Customer Service Function :

duties. Provide positive, courteous, and professional customer service support to patients and MTF staff.

members, internal staff and providers, network / outside providers and ancillary health care workers regarding

specialty clinic appointments and referrals.

Minimum Education and Experience Requirements :

All contractor personnel shall meet the minimum qualifications below :

Licensed Professionals

limited to, InterQual or Milliman Ambulatory Care Guidelines.

care setting within the last three (3) years.

restrictions, with the licensure boards in all jurisdictions in which a license is held or has been held within the last

ten (10) years.

(including Windows, Word, Excel, Outlook).

skills.

Health Requirements :

In accordance with Air Force Joint Instruction 48-110 and Air Force Instruction (AFI) 48-105, all RMC personnel shall follow

the methods for controlling and preventing disease as described in the American Public Health Association publication,

Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication,

Morbidity and Mortality Weekly Report (MMWR), and its supplements. For the purposes of this contract, the AFMS

considers RMC personnel - healthcare personnel to whom these requirements apply. Therefore, RMC personnel must

comply with all MMWR guidelines. For purposes of this contract, CDC recommendations are considered requirements.

within MTFs for the following diseases : hepatitis B, influenza, measles, mumps, rubella, varicella, Tdap, influenza.

In addition, proof of a negative TB skin test completed within the past twelve (12) months (if positive, proof of

negative chest X-ray within the past twelve (12) months) is required. The MTF will not provide immunizations or

tests for individuals not entitled to medical care.

anniversary of the employee's hire date or when the option year is executed, whichever comes first.

the rare case of post-exposure in accordance with Air Force, DoD, and CDC guidelines or recommendations.

Basic Life Support Certification :

At a minimum, any Contractor personnel working within an MTF must maintain either current certification in the

American Heart Association Basic Life Support (BLS) (Course C) or the American Red Cross CPR / BLS (Heart Saver) Course.

Any exceptions are in accordance with the local MTF / CC.

The Contractor shall ensure that RMC personnel obtain initial training at no cost to the Government prior to duty start

date so that RMC personnel arrive in their positions fully qualified; however, the Government may offer refresher training

for RMC personnel on a space-available basis. If RMC personnel receive training within the facility, the time spent in the

training course will not be billable to the Government. The Government will not pay for recertification training obtained

outside the MTF.

Absences and Leave :

Contractor personnel shall advise the FRED or other designee in FRED's absence, about absences due to illness or

incapacitation. If the contractor personnel is absent for three (3) or more consecutive days due to illness, the FRED may

require written documentation from a qualified health care provider that he or she is free from communicable

disease and the cause of the worker's current illness, if the MTF's FRED determines it is necessary.

Training :

Government Furnished Training :

The Government will provide initial on-the-job (OJT) training on Government provided forms and

equipment, initial orientation, and annual training requirements specific to the MTF. The Government

will also provide initial training, within five (5) business days of task order award, to the Contractors'

education and training department for subsequent Contractor training ("train the trainer") to their

employees on all Government provided forms, equipment, and software application systems to include,

but not limited to : HIPAA, Referral Management Business Rules, CHCS, AHLTA, RMS, MCSC referral

system, and MiCare. The Contractor's trainers shall be responsible for all future training necessary to

perform the work as defined in this PWS. Training shall not hamper the quantity, quality, or timeliness of

daily work requirements.

The AMFS designated online learning environment may be used to support pre- placement training

requirements, as available. A list of available computer-based trainings will be provided to the

Contractor within five (5) business days after contract award.

Continuous Training :

Continued certification and training required to maintain referral management proficiency of contractor

employees throughout the period of performance is the responsibility of the Contractor. Training shall

not hamper the quantity, quality or timeliness of daily work requirements.

Place of Performance :

Work will be accomplished on-site at Robins AFB, GA 31098.

Available Hours of Operation :

The Contractor shall provide Referral Management Services during normal "MTF operating hours," from

7 : 30 AM through 4 : 30 PM, Monday through Friday, excluding federal holidays.

Scheduled Holidays :

Independence Day; Labor Day; Columbus Day; Veteran's Day; Thanksgiving Day; Christmas Day.

Planned Closures :

Day, Down day) for Government employees can result in a planned facility closure.

manning / liberal leave day(s) (i.e. Family Day, Down day) when Government staff is in the facility

for oversight in accordance with MTF policy. At no time shall the contractor personnel work

without Government oversight.

Reef Systems