Ivyhill is seeking Registered Nurses (RN) / Licensed Practical Nurses (LPN) for a project in the Eglin AFB, FL area. The qualified RN will provide Referral Management (RM) activities include timely processing of Right of First Refusal (ROFR) requests, screening of specialty care referrals, sustaining up- to-date Specialty Clinic Booking Guidance, Military Treatment Facility (MTF) Capabilities Report, ROFR Reports, maintaining up-to- date MTF/Managed Care Support Contract (MCSC) Memorandums of Understanding (MOUs), comply with Referral and Authorization Business rules, tracking, accounting, and resulting of referrals, and full use of RM information management systems. Will conduct reviews for medical necessity, pre-authorizations, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities. The LPN will provide utilization management activities in the Referral Management Center.

Requirements

The qualified candidate will possess the following:

• Ability to read, understand, speak, and write English fluently.
• Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines or applicable DHA approved resource and referral and TRICARE guidelines.
• A minimum of two (2) years broad-based clinical nursing experience in either an inpatient or outpatient care setting within the last three (3) years
• Valid and unrestricted License. Be in good standing, and under no clinical restrictions, with the licensure boards in all jurisdictions in which a license is held or has been held within the last ten (10) years.
• Operational computer skills with general working knowledge of word processing, and Microsoft applications (including Windows, Word, Excel, Outlook).
• General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills.

Benefits

Ivyhill has a competitive benefits program which includes medical, dental and vision; Life and AD&D insurance; Short- and Long-Term Disability; supplemental Life insurance and a 401(k) Plan.

Ivyhill is an equal opportunity employer. In compliance with Federal and State Equal Opportunity Laws, qualified applicants are considered for all positions applied for without regard to race, color, religion, sex (including pregnancy and gender identity) , national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status or any other legally protected status.