Licensed Practical Nurse

2 days ago


Eglin AFB, United States Reef Systems Full time
Job Description

Reef Systems is seeking a highly skilled Licensed Practical Nurse to join our Referral Management team at Eglin AFB, FL.

Key Responsibilities:
  • Timely processing of Right of First Refusal (ROFR) requests
  • Screening of specialty care referrals
  • Maintaining up-to-date Specialty Clinic Booking Guidance, MTF Capabilities Report, ROFR Reports, and MTF/Managed Care Support Contract (MCSC) Memorandums of Understanding (MOUs)
  • Complying with Referral and Authorization Business rules, tracking, accounting, and resulting of referrals
  • Full use of Referral Management information management systems
  • Conducting reviews for medical necessity, preauthorization, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities
  • Providing utilization management activities in the Referral Management Center
Requirements:
  • Shall read, understand, speak, and write English fluently
  • Shall have knowledge, skills, and computer literacy to interpret and apply medical care criteria
  • Shall have a minimum of two (2) years broad-based clinical nursing experience in either an inpatient or outpatient care setting within the last three (3) years
  • License must be valid and unrestricted
  • Operational computer skills with general working knowledge of word processing, and Microsoft applications
  • General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills
Working Hours:

The Contractor shall provide qualified and trained personnel to cover the required hours of performance, Monday thru Friday, within the various facility's operational duty hours of 7:00 AM to 4:00 PM, except for Federal holidays, when the Government MTF is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings or family/down days.

Compensation:

The compensation for this role has a base pay of $22.80 with an additional $4.57 for health and welfare, totaling $27.37 hourly.

The contractor receives 80 hours of vacation time, 56 sick hours, and all federal holidays off.



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