Overview SUMMARY: The Licensed Practical Nurse (LPN) Administrative is responsible for coordinating referral management functions and ensures referral centers receive information in a timely and efficient manner to facilitate continuity of patient care

Schedule: Duty days are Mondays through Fridays. The exact hours would be dependent on where the person is working, but would be an 8-10 hours per day is anticipated and not exceed 40 hours per week. Normal place of duty is at the CMHS office.

Benefits: PTO, sick and holiday leave, Life, Accidental Death and Dismemberment, Short Term disability

Optional benefits: Medical, Dental, Vision, 401(k) matching with employee participation in 401(k) plan

Duties 1.1. The contractor shall provide consultation and administrative support for TRICARE beneficiaries. The contractor shall ensure patient flow is optimized by assisting patients (via the Central Referral Center- CRC) in processing referrals to specialty care. 1.2. Performs data collection and review to identify areas requiring intensive management. Analyzes data collected and prepares reports describing resource utilization patterns. Disseminates information to government members of collaborative teams and multidisciplinary hospital committees. 1.3. The LPN coordinates specialty care referrals. They shall review specialty care referrals for appropriateness, completeness and disposition the referral to the appropriate place of care. 1.4. The LPN serves as functional expert in the area of health benefits and provides health benefits advice to patients. 1.5. Maintains and tracks referral records. 1.6. Participates with referral centers in providing, assessing, and improving a wide variety of customer services/relations. 1.7. Assists in the management of all forms of communication between beneficiaries, referral centers, internal staff and providers, network/outside providers and ancillary health care workers. 1.8. Working knowledge of latest versions of office automation software utilized in their area of expertise required; working knowledge of Composite Health Computer System (CHCS) is required. 1.9. Professional Nursing Procedures. 1.9.1. Knows and understands the principles of utilization review and utilization management (UM) and applies knowledge in processing specialty referrals. 1.9.2. Plans and performs specialty referral reviews IAW established guidelines (InterQual, Milliman & Robertson) to provide quality cost-effective care. 1.9.3. Conducts first level reviews for all referrals to specialty care.

1.9.4. Acts a facilitator of professional and patient care activities. 1.9.5. Interfaces with the Managed Care Support Contractor (MCSC) and multidisciplinary personnel as needed to ensure appropriateness of referrals. 1.9.6. Identifies cases that may benefit from alternative levels of care and involves the case manager as needed to provide direction in care management. 1.9.7. Plans and prioritizes utilization review activities to ensure identified patient needs are addressed promptly. Prioritizes CRC requirements and makes timely and appropriate decisions. 1.9.8. Effectively utilizes information systems to develop, design, analyze, update and record data. 1.9.9. Facilitates the development and integration of UM review policies and procedures into CRC operations. 1.9.10. Performs Right of First Refusal coordination of specialty care referrals. Shall review specialty care referrals for appropriateness, completeness and disposition the referral to the appropriate place of care. 1.9.11. ROFR knowledge in the area of health benefits and provides health benefits advice to patients. 1.9.12 Maintains and tracks referral records.

Qualifications 2.1. English Language Requirement. Shall be able to read, understand, speak, and write English well enough to communicate effectively and be a United States citizen. 2.2. Education. The Licensed Practical Nurse must have successfully graduated from an approved National League of Nursing Program. 2.3. Licensure/Registration. The contract LPN shall hold a Colorado State nursing license that is valid and current with no limitations, stipulations, or pending adverse actions. License must be unencumbered and remain in effect during contract employment (at no cost to the Government).

Akahi Associates LLC

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