You'll use your clinical nursing experience to coordinate specialty care referrals that help military beneficiaries access timely, appropriate healthcare services. Working within a Referral Management Center (RMC), you'll review referrals, educate patients, collaborate with providers, and help ensure referrals move efficiently from initiation through completion while supporting continuity of care.
Schedule: Full-Time | Monday-Friday | Days (7:30 AM-4:30 PM) | Federal Holidays & Scheduled Down Days Off
Key Responsibilities
- Review, coordinate, and manage specialty care referrals from initiation through completion while ensuring compliance with TRICARE requirements, referral management business rules, and established timeliness standards.
- Assess referral completeness, verify patient eligibility and demographic information, coordinate with referring providers when additional clinical information is needed, and schedule specialty appointments within established access-to-care guidelines.
- Educate patients regarding referral processes, specialty appointments, required testing, procedures, and pre-appointment instructions while serving as a clinical resource for referral-related questions.
- Collaborate with providers, case managers, utilization management staff, specialty clinics, and network partners to facilitate appropriate referrals, resolve referral issues, and support continuity of care.
- Monitor referral activity, obtain and process specialty care documentation, maintain accurate referral records, generate referral-related reports, and help ensure referral documentation is returned to the patient's medical record within established timelines.
- Perform first-level clinical reviews of specialty referrals, identify patients who may benefit from additional care coordination, participate in quality improvement activities, and contribute to ongoing Referral Management Center operations.
Requirements
- Graduate of an accredited practical or vocational nursing program.
- Current, unrestricted Licensed Practical Nurse (LPN) license in good standing and current BLS certification through the American Heart Association or American Red Cross.
- 2+ years of broad-based clinical nursing experience in an inpatient or outpatient setting within the last three (3) years.
- Experience interpreting and applying medical necessity criteria or utilization review guidelines, such as InterQual or Milliman Ambulatory Care Guidelines.
- Working knowledge of referral management processes, electronic medical systems, Microsoft Office applications, customer service principles, and professional healthcare communication.
Preferred
- Experience supporting referral management, utilization management, case management, or care coordination within a military, government-supported, or integrated healthcare environment.
- Experience working with TRICARE, CHCS, AHLTA, HAIMS, RMS, DEERS, or similar healthcare information systems.
ll your information will be kept confidential according to EEO guidelines.
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Compensation Disclaimer:
Pay range is based on several factors and may vary in addition to a full range of medical, financial, and/or other benefits. Final salary and offer will be determined by the applicant’s background, experience, skills, internal equity, and alignment with geographical market data.
Benefits Language (FTE roles):
Full-time positions are eligible for our comprehensive and competitive benefits package including medical, dental, vision, and basic life insurance. Additional benefits include a 401k plan, paid time off, and an annual bonus. International SOS Government Medical Services complies with all federal, state, and local minimum wage laws.
Equal Opportunity Employer (EEO) Statement:
International SOS Government Medical Services is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state, and local laws.