Title: | Registered Nurse |
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ID: | 5463 |
Department: | Healthcare |
Location: | Hampton, VA |
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.
- Keep abreast of facilities’ services and medical treatment capabilities.
- 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.
- Provide patient consultation and patient education on specialty care and patient’s diagnosis.
- Ability to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care guidelines.
- 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 skill required.
Qualifications
- Graduate from an accredited Nursing program.
- Current, unrestricted, active RN licensure from any US state
- Min 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.