Job Description

Licensed Practical Nurse ( LPN) Referral Management Position

LPN services are in a non-clinical setting. The LPNs will be involved in refinement of the Referral Management (RM) process.

• LPN is responsible and accountable daily for managing and tracking all beneficiary categories (Active Duty, Active-Duty Family Members, Retirees and their Family member, survivors) of patient referrals and care authorizations to health care specialists in either the direct care or purchased care systems.
• LPN is responsible and accountable for his/her own work. Practices are monitored and evaluated for quality outcomes and cost effectiveness by the government.
• Referral Coordination services will be performed in a managed care environment. The LPN must adhere to BUMED Referral Management Guidelines, Referral Management Standard Operating Procedure (SOP), TRICARE policies and procedures, DHA-IPM 18-001, ICD-10, and DRG Codes, and financial data interpretations are essential.
• LPN is responsible for adhering to military treatment facilities (MTF) guidelines for safe work performance, including general safety procedures, identification, handling and storage of hazardous materials, physical security, and the reporting of incidents.
• Following Referral Management SOP Guidelines, the LPN will process an estimated 12 incoming/outgoing referral claim reports per year (4 reports are in support of the Overseas Contingency Operation (OCO) program and 8 reports are for all other programs).

These services are administered in compliance with state and federal regulations and meet professional standards, Navy policy, and the requirements of designated regulatory agencies. The contractor will ensure compliance with accreditation requirements and regulatory procedures including the Joint Commission.

Following Referral Management SOP Guidelines, DHA, and Naval Hospital Instructions, the LPN shall process an average/estimated over 59,000 enrollees, including 30,807 Active Duty Operating Forces. Military Health System (MHS) eligible patient referrals/consults per month to medical specialists in both the direct care and the civilian purchased care network. The LPN shall retrieve and process an estimated 3,500 (1,155 in support of OCO and 2,345 in support of all other programs) Clear and Legible Reports (CLR) that are received via Fax or mail. The processing of CLRs includes utilizing the following steps: 1) RightFax 2) Upload scanned documents into patient electronic health record. CLR processing will require retrieval of patient information utilizing a variety of computer systems to include Defense Enrollment Eligibility Reporting System (DEERS), Composite Health Care System (CHCS), HAIMS, Armed Services Health Longitudinal Technology Application (AHLTA), Care Radius, RMS Data Base's entry processes and/or contacting of patients for appointment information and entering the results into the current Referral Management Center (RMC) Data Base(s).

• The LPN shall input and retrieve patient information for each patient, through the use of various computer systems. It will take approximately 1 hour each day to perform the end of day computer processing of information to include CHCS, AHLTA, DEERS, HAIMS, Care Radius, RMS, ACDM and other computer-based programs that are in use in the RMC.
• The LPN shall utilize the Government provided telephone device to make 1500 (estimated 165 in support of OCO and 335 in support of all other programs) telephone calls per month, take messages, and follow SOP guidelines to provide referral and TRICARE health program advice to MTF or Network enrolled patients. Support includes Active Duty assigned Marine Corps Base (MCB) and Operational Forces.
• The LPN shall review an estimated 4,000 specialty care referrals per month (estimated 1,320 in support of OCO and 2,680 in support of all other programs) for appropriateness, covered benefit, administrative and medical completeness following MTF SOP guidelines.
• The LPN shall orient and train newly assigned RMC contract personnel under this contract to the Referral Management Program (RMP) and the NMCCL referral policies and procedures.
• The LPN shall utilize the CHCS, AHLTA, DEERS, HAIMS, Care Radius, RMS, ACDM and other computer-based programs that are in use in the RMC or as stated in the SOP.
• The LPN shall maintain contact with patients according to established RMC protocols to communicate appointments and individual referral information when required.

HOURS OF OPERATION

0600 - 1600 Monday through Friday

GENERAL QUALIFICATIONS TO LPN

This service requires that LPN possess the following minimum qualifications to meet job requirements.

LPN shall maintain current certification in American Heart Association Basic Life Support (BLS) for Healthcare Providers; American Heart Association Healthcare Provider Course; American Red Cross CPR (Cardiopulmonary Resuscitation) for the Professional Rescuer; or an equivalent MTF course.

Be a U.S. Citizen

LPN shall read, write, speak, and understand the English language fluently and maintain good communication and interpersonal skills sufficient to work with a variety of patients and health care professionals in the context of patient medical authorization and referral management information.

Ability to use basic software applications and type on a computer/word processor at a minimum of 30 words per minute (wpm).

Possess the necessary knowledge, skills and computer literacy with using the following software proficiency in Microsoft Word and Excel, ability to enter data and retrieve reports.

SPECIFIC QUALIFICATIONS FOR LPN working in Referral Management

Be a graduate from a Licensed Practical Nurse or Licensed Vocational Nurse Program accredited by the National League for Nursing Accrediting Commission (NLNAC).

As an alternative to the education requirement listed above in 6.6.1., the health care worker (HCW) may be a graduate of a State Board of Nursing approved LPN/LVN training program OR be a graduate of a nursing program accredited by Accreditation Commission for Education in Nursing (ACEN) OR have completed an equivalent military training program.

Possess current, unrestricted license to practice as an LVN/LPN in North Carolina.

Possess not less than 2 years full-time experience as an LPN within the past 3 years.

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