Registered Nurse – Navigator

The Copper River Family of Companies•Eglin AFB, FL

1d•Onsite

About The Position

Coho Integrated Solutions is seeking a qualified Registered Nurse – Navigator to support referral management, discharge planning, and VA-to-DoD patient transfer coordination at the 96th Medical Group at Eglin Air Force Base, Florida. The Registered Nurse – Navigator will serve as a clinical liaison between the 96th Medical Group and the Eglin Community-Based Outpatient Clinic, coordinating emergency department, inpatient transfers, outpatient referrals, discharge planning, and related clinical and administrative activities. The position requires extensive coordination with healthcare providers, VA personnel, TRICARE representatives, patients, families, and other members of the interdisciplinary healthcare team.

Requirements

U.S. citizenship is required for this contract position
Graduate of an Associate Degree in Nursing or Bachelor of Science in Nursing program from a college or university accredited by the Accreditation Commission for Education in Nursing (ACEN) or Commission on Collegiate Nursing Education (CCNE).
Current Basic Life Support (BLS) certification in accordance with applicable contract requirements.
Current, active, valid, and unrestricted Registered Nurse license from any U.S. state or territory or the District of Columbia.
Minimum of three years of clinical nursing experience.
At least one year of experience within the last two years as a Registered Nurse in inpatient care, care coordination, discharge planning, or case management.
Extensive knowledge of the Military Health System or Veterans Health Administration.
Knowledge of nursing care principles, healthcare practices, TRICARE concepts, referral management, discharge planning, and care coordination.
Working knowledge of medical necessity, utilization review, insurance processes, and healthcare reimbursement.
Knowledge of relevant requirements and standards affecting emergency transfers and discharge planning, including EMTALA.
Ability to analyze clinical and administrative information and make appropriate decisions within the scope of professional nursing practice.
Strong written, verbal, interpersonal, organizational, and problem-solving skills.
Ability to work independently while collaborating effectively with physicians, nurses, administrative personnel, patients, families, and external healthcare organizations.
Proficiency with computer applications and electronic healthcare information systems.

Responsibilities

Serve as the primary clinical liaison between the 96th Medical Group and the Eglin Community-Based Outpatient Clinic.
Coordinate VA-to-DoD patient transfers, emergency department transfers, inpatient placements, and outpatient referral services.
Support safe and timely discharge planning, including coordination of durable medical equipment, home health care, specialty referrals, follow-up appointments, and community resources.
Screen and process specialty care referrals, authorizations, Right of First Refusal (ROFR) requests, and related referral-management activities.
Conduct medical necessity, preauthorization, medical appeal, utilization review, and insurance-related activities as required.
Coordinate with VA providers, 96th Medical Group physicians, specialists, supervisors, receiving units, utilization management, case management, and social work personnel.
Apply evidence-based utilization and discharge planning tools, including InterQual and Milliman guidelines, as appropriate.
Monitor admission appropriateness, length of stay, discharge criteria, and transfer requirements to minimize avoidable delays in patient care.
Educate patients, families, providers, and staff regarding discharge planning, referrals, transfers, post-discharge care, and available resources.
Coordinate with third-party payers and TRICARE Managed Care Support Contractors to support authorization and reimbursement requirements.
Maintain accurate documentation and referral-management records using MHS GENESIS and authorized VA systems.
Participate in quality improvement initiatives, committees, working groups, training, and process improvement activities designed to improve referral and transition-of-care processes.