(Archived) Licensed Practical Nurse

Licensed Practical Nurse (Admin)

Location: CMHS, Colorado Springs, CO

Work Schedule: Duty days are Mondays through Fridays. The exact hours would be dependent on where the person is working, but would be an 8-10 hours per day is anticipated and not exceed 40 hours per week. Normal place of duty is at the CMHS office.

SUMMARY: The Licensed Practical Nurse (LPN) Administrative is responsible for coordinating referral management functions and ensures referral centers receive information in a timely and efficient manner to facilitate continuity of patient care.

1.0. DUTIES:
1.1. The contractor shall provide consultation and administrative support for TRICARE beneficiaries. The contractor shall ensure patient flow is optimized by assisting patients (via the Central Referral Center- CRC) in processing referrals to specialty care.
1.2. Performs data collection and review to identify areas requiring intensive management. Analyzes data collected and prepares reports describing resource utilization patterns. Disseminates information to government members of collaborative teams and multidisciplinary hospital committees.
1.3. The LPN coordinates specialty care referrals. They shall review specialty care referrals for appropriateness, completeness and disposition the referral to the appropriate place of care.
1.4. The LPN serves as functional expert in the area of health benefits and provides health benefits advice to patients.
1.5. Maintains and tracks referral records.
1.6. Participates with referral centers in providing, assessing, and improving a wide variety of customer services/relations.
1.7. Assists in the management of all forms of communication between beneficiaries, referral centers, internal staff and providers, network/outside providers and ancillary health care workers.
1.8. Working knowledge of latest versions of office automation software utilized in their area of expertise required; working knowledge of Composite Health Computer System (CHCS) is required.
1.9. Professional Nursing Procedures.
1.9.1. Knows and understands the principles of utilization review and utilization management (UM) and applies knowledge in processing specialty referrals.
1.9.2. Plans and performs specialty referral reviews IAW established guidelines (InterQual, Milliman & Robertson) to provide quality cost-effective care.
1.9.3. Conducts first level reviews for all referrals to specialty care.
1.9.4. Acts a facilitator of professional and patient care activities.
1.9.5. Interfaces with the Managed Care Support Contractor (MCSC) and multidisciplinary personnel as needed to ensure appropriateness of referrals.
1.9.6. Identifies cases that may benefit from alternative levels of care and involves the case manager as needed to provide direction in care management.
1.9.7. Plans and prioritizes utilization review activities to ensure identified patient needs are addressed promptly. Prioritizes CRC requirements and makes timely and appropriate decisions.
1.9.8. Effectively utilizes information systems to develop, design, analyze, update and record data.
1.9.9. Facilitates the development and integration of UM review policies and procedures into CRC operations.
1.9.10. Performs Right of First Refusal coordination of specialty care referrals. Shall review specialty care referrals for appropriateness, completeness and disposition the referral to the appropriate place of care.
1.9.11. ROFR knowledge in the area of health benefits and provides health benefits advice to patients.
1.9.12 Maintains and tracks referral records.

2.0. QUALIFICATIONS:
2.1. English Language Requirement. Shall be able to read, understand, speak, and write English well enough to communicate effectively and be a United States citizen.
2.2. Education. The Licensed Practical Nurse must have successfully graduated from an approved National League of Nursing Program.
2.3. Licensure/Registration. The contract LPN shall hold a Colorado State nursing license that is valid and current with no limitations, stipulations, or pending adverse actions. License must be unencumbered and remain in effect during contract employment (at no cost to the Government).
2.4. Certification. The LPN must have a current Basic Cardiac Life Support (BLS) certificate by the American Red Cross. Advanced Cardiac Life Support (ACLS) and Certified Professional in Healthcare Management (CPHM) certification is not mandatory, but desirable. Certification shall be maintained in a current status at all times while performing services under this contract at no expense to the Government or increase cost to the contract.
2.5. Experience. The LPN shall be knowledgeable in general medical ethics, health records administration, excellent communications and customer service skills. The LPN must have a minimum of two years of clinical experience.
2.6. The LPN must have working knowledge of computers, specifically the Internet, Microsoft Word, Microsoft Access, Microsoft Excel and Windows.

Akahi Associates Services

Akahi Services is a premier provider of healthcare workers to various military treatment facilities across the United States. With a corporate office in Honolulu, Hawaii, and recruiting office in San Antonio, Texas we specialize in providing skilled, trained, and highly successful healthcare workers, including RNs, CRNAs, Physicians, LPN/LVN, Licensed Social Workers, and many more.

We have a strong focus on providing our government customers with quality and superior service.

Akahi Services is an equal opportunity employer and Minorities, Females, Veterans, and Disabled persons are encouraged to apply. For further information, please click the link below to view the EEOIs The Law poster.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

Only qualified individuals who are being considered will be contacted for an interview