Licensed Practical Nurse (LPN/LVN) - Referral Management Center job in Sumter, South Carolina.
- Days Only
- Full-time hours
- Holidays off (and paid)
- Benefits (health, dental, and vision)
- Civilian position on Shaw Air Force Base
Licensed Practical Nurse (LPN/LVN) - Referral Management Center Job Overview:
The position is a civilian position on Shaw AFB. Civilian and military healthcare providers work together to provide a full range of services to the military community.
The Referral Management Center (RMC) serves as the central clearinghouse for providers and patients needing information or help with referrals. Referral Management is a critical program supporting the patient-centered mission.
- Review initial specialty care and deferred to network primary care referrals for administrative completeness
- Coordinate with specialty referral clinics.
- Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.
- Track initial specialty care and deferred to Network primary care referrals to include obtaining reports from MTF, ODCS, network, and non-network providers.
- Provides patient education regarding specialty care referral, procedures, labs, etc to prepare the patient for their specialty care appointment/procedure.
- Facilitates professional and patient care activities.
- Conducts first level reviews for all referrals to specialty care.
- Identifies cases that may benefit from alternative levels of care and involves the case manager as needed to provide direction in care management/coordination.
- Provides nursing consultation and patient education on specialty care and patient's diagnosis.
Licensed Practical Nurse (LPN/LVN) - RMC Job Qualifications:
- Graduate from a NLNAC or CCNE accrediated program
- LPN License: any U.S. state honored. active, unrestricted.
- 2 years of healthcare administrative experience in either an inpatient or outpatient care setting within the last 3 years, highly preferred
- TRICARE - working knowledge
- Knowledge and skills to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
- Working knowledge of APGs, DRGs, ICD-9, and CPT-4 coding.
- Excellent oral and written communication skills and interpersonal skills
- Working knowledge of computers (Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows)
- HIPAA knowledge