The Referral Management Center (RMC) serves as the central clearinghouse for providers and patients needing information or help with referrals. Referral Management is a critical program supporting the patient-centered mission.

• Review initial specialty care and deferred to network primary care referrals for administrative completeness
• Coordinate with specialty referral clinics.
• Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.
• Track initial specialty care and deferred to Network primary care referrals to include obtaining reports from MTF, ODCS, network, and non-network providers.
• Provides patient education regarding specialty care referral, procedures, labs, etc. to prepare the patient for their specialty care appointment/procedure.
• Facilitates professional and patient care activities.
• Conducts first level reviews for all referrals to specialty care.
• Identifies cases that may benefit from alternative levels of care and involves the case manager as needed to provide direction in care management/coordination.
• Provides nursing consultation and patient education on specialty care and patient's diagnosis.

Licensed Vocational Nurse (LVN/LPN) - RMC Job Qualifications:

• Graduate from a NLNAC or CCNE accredited program.
• LVN License: any U.S. state honored. active, unrestricted.
• Two (2) years of healthcare administrative experience in either an inpatient or outpatient care setting within the last three (3) years, highly preferred.
• TRICARE - working knowledge.
• Knowledge and skills to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
• Working knowledge of APGs, DRGs, ICD-9, and CPT-4 coding.
• Excellent oral and written communication skills and interpersonal skills
• Working knowledge of computers (Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows).
• HIPAA knowledge a must.