Job Listing
Nurse (Utilization Management / Referral Management)
Military Treatment Facilities under DHA · Posted 116 days ago
About the Role
About the Position: This position is located in the Healthcare Business Directorate, Naval Health Clinic Annapolis. Work hours: 0700/730-1600/1630 This is a Direct Hire Authority (DHA) solicitation utilizing the DHA for Certain Personnel of the DoD to recruit and appoint qualified candidates to positions in the competitive service.
What You'll Do
- →Ensure that all emergent referrals are submitted to the Managed Care Support Coordinator (MCSC) within same business day and coordinates to expedite patient appointment for all emergent referrals.
- →Evaluate the appropriate level of care for referrals and TRICARE Plus network referrals by reviewing the referrals, health care plans and historical care provided to the patient.
- →Serve as a resource and assist providers with interpretation of guidelines and criteria for referrals and TRICARE Plus referrals.
- →Consult with providers regarding specific anomalies to the network management plan.
- →Educate medical staff on proper referral inputs and necessary medical language within referrals.
- →Manage day-to-day operations of the Referral Management Center by providing clinical guidance and direction on tracking and processing of referrals.
- →Develop and maintain referral guidelines and business rules in coordination with IRMAC.
Requirements
- ✓For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
Personality Fit
Job ID: ac9ad725-9010-4717-87f9-d1688fcfec25
Posted via USAJobs