LPN REFERRAL MANAGEMENT CENTER

At General Infomatics, Inc we pride ourselves on providing program support, healthcare services, strategic technology solutions, and knowledge management to US government agencies worldwide, under standards of integrity, trust, and a commitment to excellence.

We are looking for a LICENSED PRACTICAL NURSE FOR REFERRAL MANAGEMENT CENTER for a full time, civil contract position at McConnell AFB, KS (Monday to Friday 7 : 30am to 4 : 30pm)

MAIN RESPONSIBILITIES :

Reviews referrals for administrative, clinical completeness and appropriateness. Validates requested medical service, and authorizes surgery / medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues or concerns.

Schedules referral appointments in accordance with required Access to Care Standards within the direct care system or outside the MTF with network / non-network providers. Ensures appointing is done within the Access to Care standards for 90% of all referrals.

Coordinates with specialty referral clinics (internal or external) to obtain special patient instructions and / or tests required prior to appointment. Provides pre-appointment instructions to patients as well as the details regarding their referral appointment (i.e., date / time, provider, and location). Ensures patients receive necessary documentation appropriate for the referred medical care visit.

Locates referral requests and ensures appropriate documents are available prior to all specialty appointments.

Verifies eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS).

Facilitates referral activities by participation in multidisciplinary team activities. Initiates / coordinate communication between beneficiaries, team members, internal staff and providers, network / outside providers and ancillary health care workers. Provides timely, descriptive feedback regarding utilization review issues.

Interfaces with the Managed Care Support Contractor (MCSC) and multidisciplinary personnel as need to ensure appropriateness of referrals. Submits referrals to non-network providers to TRICARE Service Center (TSC) for medical necessity / appropriateness review.

Receives and makes patient telephone calls and computer / written correspondence regarding specialty clinic appointments and referrals.

Tracks referral reports after appointments are kept. Ensures that results from other MTFs and from network / non-network providers are returned to the referring provider and to the medical record within required timelines and follow up with as necessary.

QUALIFICATIONS, SKILLS AND REQUIREMENTS

• Associate of Science in Nursing Program accredited by the Accreditation Commission for Education in Nursing (ACEN, formerly NLNAC).
• License / certification. Current, active, full, and unrestricted License to practice Nursing in accordance with State Board requirements. Nurse applicants must be a current U.S. Licensed Practical Nurse. License cannot be under investigation nor have any adverse action pending from a Nursing State Board or national licensing / certification agency.
• 6 years of clinical nursing experience is required. Previous experience in Utilization Management is not required. Full time employment in a nursing field within the last 36 months is mandatory.
• Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
• Possess excellent oral and written communication skills, interpersonal skills, and have working knowledge of computers, specifically the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows.
• Highly desired : reliable transportation to commute back and forth to work at base.

SALARY AND BENEFITS

Come join our team!

We encourage our Veterans and Military Spouses to apply and self-identify during the recruitment process.

General Infomatics (GI) is a minority-owned, Service-Disabled Veteran Owned Small Business (SDVOSB), headquartered in McLean, VA. We are ISO 9001 : 2008 Quality Management System (QMS) Certified.

Gold Hire Vets Medallion - Department of Labor

Member of the Military Spouse Employment Partnership - Department of Defense

Discover the Talent Program - Hire our Heroes - US Chamber of Commerce Foundation

Certified V3 (Virginia Values Veterans) Company - Commonwealth of Virginia

Equal opportunity / Affirmative action employer

Must be able to pass a US government security investigation and a thorough job verification.

Please make sure your resume is accurate and updated when you apply for this job. As part of our recruiting process, we will ask applicants to authorize a thorough job verification. Omitted jobs, falsified dates, or any type of misrepresentation will automatically disqualify the candidate.

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