Licensed Practical Nurse – Referral Management Center
Minimum Qualifications: • Degree: Certificate. • Education:Graduation from a State Board of Nursing approved LPN/LVN training program or completion of equivalent military training that permits sitting for the State licensure examination. • Experience:Current experience requirement is one year in the last two years as a practical or vocational nurse. • Licensure: Current, full, active and unrestricted license as a practical or vocational nurse.
CoreDuties: • Reviews referrals for administrative, clinical completeness and appropriateness. Validates requested medical service, and authorizes surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF
Liaison to address any process issues or concerns. • Schedules referral appointments in accordance with required Access to Care Standards within the direct care system or outside the MTF with network/non-network providers for 90% of all referrals. • Provides timely, descriptive feedback regarding utilization review issues. • Reviews and enters first right of refusal referrals into CHCS and database within one (1) business day of the date of the referral. • Submits referrals to non-network providers to TRICARE Service Center (TSC) for processing. • Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. • Tracks referral reports; obtain referral results within the required timelines and follow up with as necessary. Documents that paper referral results are properly filed in patient’s health record.