Job purpose To provide assistance at the Referral Management Service Center with primary care and specialty care services in a patient-centered environment to active-duty service members and their families for 8-koi; a diverse Florida based service and consulting company that has been providing outstanding results for our clients for over 12-years.
Position is contingent upon contract award.
Duties and responsibilities Review initial specialty care and deferred to network primary care referrals for administrative completeness.
Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.
Track initial specialty care deferred to network primary care referrals to include obtaining reports from MTF, network and non-network providers.
Provide patient education on specialty care referral, procedures, and labs to prepare the patient for their appointment or procedure.
Facilitate professional and patient care activities.
Ability to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care guidelines.
Provide patient consultation and patient education on specialty care and patient’s diagnosis.
Identify cases that may benefit from alternative levels of care and involves the case managers as needed to provide direction in care management/coordination.
General medical ethics, telephone etiquette and customer service skills required.
Qualifications Graduate from an accredited Licensed Practical Nursing program.
Minimum of 2 years broad-based clinical nursing experience in either inpatient or outpatient care setting within the last 3 years.
Basic Life Support (BLS) certification with the American Heart Association or American Red Cross CPR/BLS.
Skilled in Word, Excel, and other Microsoft Office software programs.
Knowledge of TRICARE preferred HIPAA Knowledge required Working conditions Working conditions are within a normal office environment.
Physical requirements Normal office environment mobility; sitting, walking, bending, stooping, standing, lifting a maximum of 25 pounds (greater than 25 pounds requires a two-person lift), turning, pushing.
Normal office dexterity, to include; reaching, handling, grasping, to include typing/keyboard, and phone use.