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Licensed Practical Nurse - Referral Management Center

Responsibilities:

ABOUT AVOSYS

Avosys is a growing integrator of professional, technological and management solutions services. Founded in 1998, Avosys provides services nationwide to Federal, Commercial, Local and State clients. We recognize the foundation of our firm is our people and we continue to rise above our competition by hiring the best.

DESCRIPTION

Avosys is seeking a Licensed Practical Nurse Referral Management Center to provide services to the military and their families at McConnell AFB, KS.

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. Prints diagnostic reports and/or treatment profiles as necessary.
  • 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.
  • Reviews and enters first right of refusal referrals into CHCS and database within one (1) business day of the date of the referral.
  • 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.
  • Performs data collection and review to identify areas requiring intensive management. Refers to case management officials if needed.
  • Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors referral management CHCS queue to ensure patients are being called that do not utilize the RMC walk-in service.
  • Contacts patients in event referral requests are invalid, disapproved by second level review/MCSC and reschedules patients as soon as possible or instructs patients of other health care options.
  • Receives and appropriately forwards clinical phone consult requests from patients.
  • Advises patients of what their referral/health treatment options are as related to their eligibility per beneficiary status and covered benefits. This includes eligibility for travel benefits.
  • Coordinates with Aerovac units to make travel arrangements with the Global Patient Movement Requirements Center using the TRANSCOM Regulating and Command and Control Evacuation System as indicated. Ensures Aerovac personnel arrange travel orders and non-medical attendants as required for the patient and the patient is informed.
  • Advises on Line-of-Duty issues.
  • Obtains pertinent information from patients/callers, referrals, physician or other officials. Enters data in CHCS, AHLTA, MHS GENESIS, Referral database, and other office automation software programs as appropriate.
  • 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 the required timelines and follow up with as necessary. Documents that paper referral results are properly filed in patient's health record.

QUALIFICATIONS

  • Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
  • Working knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Version 9 (ICD), and Current Procedural Terminology-Version 4 (CPT-4) coding.
  • 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.
  • Associate of Science in Nursing Program from an approved National League of Nursing.
  • 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.
  • Equivalent combinations of education and experience may be qualifying if approved by the requesting location and the Contracting Officer. If education or experience is used to meet the specialized requirements of this position, it must be directly related to referral/utilization management.

Position is contingent upon award of contract

Reference Code:
MSS. KS. LPN. 1812
Position Type:
Full Time
Location:
McConnell AFB, KS
Industry:
Government Contracting
Shift:
Day Business Hours
Travel:
No
Salary:
Based on Experience
Telework:
No

Equal Opportunity Employer/Veterans/Disabled

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact (210) 888-0775 orJobs@Avosys. comfor assistance.

Avosys
https://avosys. applicantpro. com


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