Clinical Referral Coordinator

4 weeks ago

Hurlburt Field, Florida, United States Reef Systems Full time
Job Summary:

The Licensed Practical Nurse will provide Referral Management activities, including timely processing of Right of First Refusal (ROFR) requests, screening of specialty care referrals, and maintaining up-to-date Specialty Clinic Booking Guidance. The individual will conduct reviews for medical necessity, preauthorization, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities. The Licensed Practical Nurse will provide utilization management activities in the Referral Management Center.

Responsibilities:

Conduct reviews for medical necessity, preauthorization, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities.
Provide Referral Management activities, including timely processing of Right of First Refusal (ROFR) requests, screening of specialty care referrals, and maintaining up-to-date Specialty Clinic Booking Guidance.
Provide 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, such as InterQual or Milliman Ambulatory Care Guidelines or applicable DHA approved resource and referral and TRICARE guidelines.
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 (including Windows, Word, Excel, Outlook).
General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills.

Working Conditions:

The Contractor shall provide CP for conducting business 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.

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