Licensed Practical Nurse (LPN) - Keesler AFB, MS 39534

Reef Systems • Biloxi, MS

8d • Onsite

About The Position

Reef Systems has an immediate need for a Licensed Practical Nurse (LPN) to support the Air Force Medical Service (AFMS) mission at the Referral Management Center (RMC) located at Keesler AFB, MS. This is a full-time, on-site position. The Air Force Medical Service (AFMS) operates and manages a worldwide healthcare system to deliver medical service for more than 2.63 million eligible beneficiaries, including active duty, family members, and retirees. The AFMS responds to a full spectrum of anticipated health requirements and provides an integrated healthcare system with an emphasis on prevention of illness and injury. Referral Management (RM) is a critical process within the AFMS. When specialty care is referred, the Referral Management Center (RMC) is responsible for advising the patient of their benefit, working with the referring provider and the Managed Care Support Contractor (MCSC) to ensure the referral is accurate, coordinating the referral with the specialty office, facilitating the recapture of Medical Treatment Facility (MTF) direct care capabilities, tracking the referral to closure, and returning all results of treatment to the patient’s medical record. The RMC serves as the central clearing house for providers and patients needing information or help with referrals. The Contractor shall support the AFMS’ mission of staffing and managing RMCs at the MTFs, serving as the one-stop shop for all referrals from initiation to receipt of a clear, legible, HIPAA-compliant report.

Requirements

• Read, understand, speak, and write English fluently.
• Knowledge, skills, and computer literacy to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
• 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.
• Contract personnel shall be in good standing, and under no clinical restrictions, with the licensure boards in all jurisdictions in which a license is held or has been held within the last ten (10) years.
• 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.
• In accordance with Air Force Joint Instruction 48-110 and Air Force Instruction (AFI) 48-105, all RMC personnel shall follow the methods for controlling and preventing disease as described in the American Public Health Association publication, Control of Communicable Diseases Manual, and the Centers for Disease Control and Prevention (CDC) publication, Morbidity and Mortality Weekly Report (MMWR), and its supplements.
• RMC personnel must comply with all MMWR guidelines.
• Proof of immunization for hepatitis B, influenza, measles, mumps, rubella, varicella, Tdap, influenza.
• Proof of a negative TB skin test completed within the past twelve (12) months (if positive, proof of negative chest X-ray within the past twelve (12) months).
• Maintain either current certification in the American Heart Association Basic Life Support (BLS) (Course C) or the American Red Cross CPR/BLS (Heart Saver) Course.
• Obtain initial training at no cost to the Government prior to duty start date.

Nice To Haves

• The Government may offer refresher training for RMC personnel on a space-available basis.
• The Government will provide initial on-the-job (OJT) training on Government provided forms and equipment, initial orientation, and annual training requirements specific to the MTF.
• The Government will also provide initial training, within five (5) business days of task order award, to the Contractors’ education and training department for subsequent Contractor training (“train the trainer”)

Responsibilities

• Operate the RMC at the MTFs and provide referral management services to patients during normal MTF business hours for telephonic, electronic, and in-person access.
• Process and review referrals in Government information systems including MHS GENESIS, CHCS, MCSC referral systems, AHLTA, HAIMS, and RMS ICD-B programs.
• Accurately refer patients to subsequent care using the most current MTF Capabilities Report, Access to Care (ATC) standards, and RMC Business Rules.
• Initiate, follow, manage, and close all referrals within timeliness standards identified in the TRICARE Operations Manual, RMC business rules, and other Government policies.
• Provide patient education on specialty care referrals, procedures, and labs.
• Provide MTF clinical personnel education concerning the referral process and timelines semi-annually.
• Identify and notify the Government MTF case manager, Utilization Management (UM) nurse, or Primary Care Management (PCM) team of any patient that may benefit from or require care management/coordination.
• Sustain and follow the most current MTF Specialty Clinic Booking Guidance, MTF Capabilities Report, and MTF/MCSC Memorandums of Understanding.
• Participate in inspections by providing any requested referral management information.
• Review initial specialty care and deferred-to network primary care referrals for administrative completeness, covered TRICARE benefit, and required tests/pre-work.
• Coordinate with referring providers for additional referral information.
• Verify patients are registered in CHCS and DEERS; update demographic and other pertinent information.
• Obtain current and accurate patient contact information.
• Determine patient eligibility for services and schedule specialty referral appointments to MTF or Other Direct Care System (ODCS) using CHCS booking procedures, ATC standards, and established clinic capability/booking protocols.
• Defer referrals to the network through the MCSC if no MTF or ODCS referral appointments are available within ATC standards.
• Transmit referrals through the RMS to the MCSC.
• Assist with ROFR determinations for specialty care within the MTF.
• Document patient appointments in approved AFMS system(s) (e.g., CHCS, RMS, ALTHA).
• Enter ROFR-type referrals into CHCS for review and appointments.
• Process ROFRs within the time limits outlined in the TRICARE Operations Manual.
• Accept/decline urgent priority ROFRs and outside referral requests within thirty (30) minutes of receipt.
• Accept/decline routine priority ROFRs and outside referral requests within one (1) business day of receipt.
• Return completed referrals submitted by network/VA provider’s specialty care referral results (ROFR results) to the referring purchased care provider within ten (10) business days of the kept specialty encounter.
• Verify that referrals are activated within the referral priority standards (Routine, Emergent, and Urgent).
• Assist with appointing/activating referrals and providing customer support to patients.
• Correct inaccurate authorizations in the RMS.
• Coordinate with specialty referral clinics on special patient instructions and tests required prior to appointment.
• Provide pre-appointment instructions to patients.
• Advise patients of the provider, location, time, and day of referral appointments or request the patient to call back for appointment information.
• Include care episode information for the referral provider as to where to return referral results.
• Assist the PCM/team by faxing documents to the specialist’s office when requested by the referring provider/team.
• Contact and inform patients in the event referral requests are invalid or disapproved.
• Reschedule or instruct patient of other health care options within two (2) business days of notification of referral being invalid or disapproved.
• Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.
• Utilize the referral naming convention in Telephone Consults (T-Cons), AHLTA clinical notes and HAIMs, or additional systems.
• Return all calls within two (2) business days.
• Monitor the secure messaging box three (3) times a day for messages.
• Follow-up with patients and/or direct messages to the PCM team accordingly.
• Generate and forward referral-related patient telephone consults requiring clinical decision-making to the appropriate provider/team.
• Review TRICARE Regional Office reconciliation/summary report daily; identify all open referrals and ensure resubmission.
• Track and obtain initial specialty care and deferred to Network primary care referrals, including obtaining CLRs from MTF, ODCS, network, and non-network providers.
• Ensure received specialist results are sent to the referring provider or PCM.
• Retrieve CLRs no later than (NLT) (180) calendar days after the order entry date.
• Research (chase) and expeditiously retrieve CLRs if not received within (180) calendar days.
• Import/scan CLRs into the correct patients’ medical record within three (3) business days from receipt of results.
• Return CLR results to the referring provider or PCM within three (3) business days of receipt from the consulted provider/specialist.
• Follow-up with MTF specialty care providers who did not complete CLR referral results.
• Provide the referring providers a monthly list of their referred patients who have not scheduled their initial specialty care appointment.
• Provide initial results of all referrals written by the MTF.
• Send all referrals to the referring provider/PCM for review to be tracked and closed.
• Prepare referral management data reports/metrics using referral tracking data tools.
• Accurately advise all patients of their referral eligibility, beneficiary status, and health treatment options.
• Coordinate with MTF Chief of Medical Staff (SGH) for all active, reserve, and guard referrals not covered under the TRICARE benefit for approval.
• Direct patient to patient travel coordinator and provide information on travel related benefits.
• Assist MTF, as necessary, on advising patients regarding Line-of-Duty, Personal Reliability Program (PRP), and Medical Evaluation Board issues.
• Verify appropriate paperwork is on file prior to authorization.
• Provide medical ethics, telephone etiquette, office, administrative, and clerical skills to perform receptionist duties.
• Provide positive, courteous, and professional customer service support to patients and MTF staff.
• Initiate, receive, and coordinate communication between beneficiaries, team members, internal staff and providers, network/outside providers, and ancillary health care workers regarding specialty clinic appointments and referrals.
• Resolve substantiated complaints within five (5) business days of receipt of complaint.

Benefits

• The MTF will not provide immunizations or tests for individuals not entitled to medical care.
• Proof of subsequent immunizations, required for continued employment at the MTF, must be provided on the anniversary of the employee’s hire date or when the option year is executed, whichever comes first.
• The MTF will not perform any medical tests or procedures required by the contract for non-beneficiaries except in the rare case of post-exposure in accordance with Air Force, DoD, and CDC guidelines or recommendations.
• If RMC personnel receive training within the facility, the time spent in the training course will not be billable to the Government.
• The Government will not pay for recertification training obtained outside the MTF.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed