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.
- 2 years of healthcare administrative experience in either an inpatient or outpatient care setting within the last 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, andCPT-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