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.