Licensed Practical Nurse (LPN) - Moody AFB, GA

Licensed Practical Nurse (LPN) – Moody AFB, GA Reef Systems has an immediate need for a Licensed Practical Nurse (LPN) to support the Air Force medical Service (AFMS) mission at the Referral Management Center (RMC) located at Moody AFB, GA. This is a full-time, on-site position. Description of Services The AFMS operates a worldwide healthcare system to deliver medical services for more than 2.63 million eligible beneficiaries, including active duty members, family members, and retirees. The RMC coordinates referrals between the referring provider, MCSC, and patients, and ensures referrals are accurate and documented in the patient’s medical record. The RMC serves as the central clearinghouse for information or help with referrals and supports patient-centered medical home models and expeditionary medicine platforms. Scope The Contractor shall support the AFMS mission by staffing and managing RMCs at MTFs, serving as the one-stop shop for referrals from initiation to receipt of a HIPAA-compliant report returned to the MTF. The RMC coordinates referrals with providers and patients and optimizes MTF clinical capabilities and related platforms. Summary of Requirements Referral Management Center (RMC) Operations Operate the RMC at the MTFs listed within Appendix A. Provide referral management services to patients during normal MTF business hours (as specified in paragraph 4) for telephonic, electronic, and in-person access. Process and review referrals in Government information systems including MHS GENESIS, CHCS, MCSC referral systems, AHLTA, HAIMS, RMS ICD-B, and related programs. Accurately refer patients to subsequent care using current MTF Capabilities Report, ATC standards, and RMC Business Rules as outlined in AFI 44-176 and the AFMS RMC Guide – version 9.0. Initiate, follow, manage, and close all referrals within timeliness standards identified in TRICARE Operations Manual, RMC business rules, and other Government policies. Provide patient education about referrals, procedures, and labs to prepare for specialty care appointments or procedures. Provide MTF clinical personnel education on referral processes and timelines, at least semi-annually, including provider/nurse orientation briefings and ProStaff meetings. Identify and notify the Government MTF case manager, UM nurse, or PCM team as appropriate for care management/coordination. Support and utilize MTF Specialty Clinic Booking Guidance, MTF Capabilities Reports, and MOUs to maximize recapture initiatives and enhancements. Participate in inspections by providing requested referral management information as needed. Referral Review/Appointing Function Review initial specialty care and deferred-to-network primary care referrals for administrative completeness, coverage, and required tests. Coordinate with referring providers if additional information is needed. Verify patient registration in CHCS and DEERS; update demographic information and obtain current contact information. Determine patient eligibility for services and schedule specialty referrals to MTF or ODCS using CHCS booking procedures, ATC standards, and clinic protocols. If no suitable appointments exist, defer to the network via MCSC and transmit the referral through RMS. Assist with ROFR determinations for specialties within MTF availability using service listings and information systems linked to appointments. Document appointments in approved AFMS systems (e.g., CHCS, RMS, ALTHA). Enter ROFR referrals into CHCS for review and scheduling. Process ROFRs within TRICARE Manual time limits and accept/decline urgent and routine ROFRs within specified timeframes. Return completed referrals submitted by network/VA providers within 10 business days of the specialty encounter. Verify referrals are activated within priority standards (Routine, Emergent, Urgent) and assist with patient support per AFMS RMC rules. Correct inaccurate authorizations in RMS; coordinate with specialty clinics on patient instructions and required tests; provide pre-appointment instructions to patients when possible. Obtain and transmit clinical documents requested by purchased care providers; assist PCM teams by faxing documents as needed. For STAT/ASAP referrals, the ordering provider is responsible for obtaining and sending information. Inform patients if referral requests are invalid or disapproved and reschedule or offer alternatives within 2 business days. Submit referrals for medical necessity review as required and use the referral naming conventions in relevant systems. Return calls within 2 business days and monitor secure messaging three times daily to follow up with patients or the PCM team. Generate and forward referral-related patient telephone consults requiring clinical decision-making to the appropriate provider/team. Referral Tracking Function Track initial specialty care and deferred-to-network referrals, retrieve CLRs from MTF/ODCS/network providers, and ensure follow-up results are sent to the referring provider or PCM. Retrieve CLRs no later than 180 days after order entry; expeditiously locate CLRs if not received within 180 days as per AFMS rules. Import/scan CLRs into the patient’s medical record within 3 business days and return CLR results to the referring provider or PCM within 3 business days of receipt from the provider. Follow up with MTF specialty care providers who did not complete CLR results per AFMS RMC rules. Provide the referring provider a monthly list of patients who have not scheduled initial specialty care appointments. Provide initial results of all referrals written by the MTF and send to the referring provider/PCM for review and tracking. Prepare referral management data reports/metrics as determined by AFMS RM rules and local policies; ensure accuracies within 3 business days and support recapture efforts. Health Benefits Function Advise patients of referral eligibility, beneficiary status, and health treatment options per TRICARE enrollment/DEERS status. Coordinate with the MTF Chief of Medical Staff for referrals not covered under TRICARE for approval. Direct patients to travel coordinators and provide information on travel-related benefits. Customer Service Function Provide medical ethics, telephone etiquette, and clerical skills to perform receptionist duties and deliver professional customer service to patients and MTF staff. Initiate and coordinate communication between beneficiaries, team members, internal staff, and providers regarding specialty clinic appointments and referrals. Resolve substantiated complaints within five (5) business days of receipt. Minimum Education and Experience Requirements All contractor personnel shall meet the minimum qualifications below: Licensed Professionals English fluency in reading, writing, and speaking. Knowledge of medical care criteria (e.g., InterQual, Milliman guidelines). Minimum of two (2) years of broad-based clinical nursing experience in inpatient or outpatient settings within the last three (3) years. Valid, unrestricted license in jurisdictions held in the last ten years; in good standing with no clinical restrictions. Operational computer skills (word processing and Microsoft applications). General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills. Health Requirements All RMC personnel shall follow DoD/AF guidance on disease control and CDC guidelines. Proof of immunizations and a negative TB test within the last 12 months are required; some requirements apply to non-beneficiaries under certain conditions. Provide proof of immunizations (hepatitis B, influenza, measles, mumps, rubella, varicella, Tdap, influenza) and a negative TB test or chest X-ray within 12 months. Immunizations for non-beneficiaries are not provided by the MTF. Immunization proof/continued immunizations must be provided on the anniversary of hire date or option year. MTF will not perform medical tests for non-beneficiaries except as allowed by policy and guidelines. Basic Life Support Certification Contractor personnel must maintain current BLS (AHA Course C) or Red Cross CPR/BLS; exceptions follow local MTF/CC decisions. Training will be provided at no Government cost before start date; ongoing training may be on a space-available basis. Absences and Leave Contractor personnel must notify FRED of absences due to illness. If absent for 3+ consecutive days, documentation from a qualified provider may be required to confirm fitness to work. Training Government Furnished Training The Government will provide initial OJT on forms and equipment, orientation, and annual training specific to the MTF. The Government will provide training for the Contractor’s education and training department to train employees on all Government forms, equipment, and software (HIPAA, Referral Management Rules, CHCS, AHLTA, RMS, MCSC, MiCare). Trainers will support ongoing training. Training should not hinder daily work. The AMFS online learning environment may be used for pre-placement training. A list of available computer-based trainings will be provided within five (5) business days after contract award. Continuous Training Ongoing certification and training required to maintain referral management proficiency is the responsibility of the Contractor and should not impede daily work. Place of Performance On-site at Moody AFB, GA. Available Hours of Operation Referral Management Services during normal MT F operating hours: 7:30 AM – 4:30 PM, Monday through Friday, excluding federal holidays. Scheduled Holidays New Year’s Day; Martin Luther King Jr. Birthday; President’s Day; Memorial Day; Juneteenth; Independence Day; Labor Day; Columbus Day; Veterans Day; Thanksgiving Day; Christmas Day. Planned Closures Days designated as minimal manning or liberal leave days may result in planned facility closures. The contractor personnel may perform duties during minimal manning/ liberal leave days only with Government oversight and per MTF policy. #J-18808-Ljbffr