5 Referral Management Center Registered Nurse Jobs in Biloxi, MS
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Referral Management Center Registered Nurse
$73k-92k (estimate)
Full Time | IT Outsourcing & Consulting
1 Month Ago
Reef Systems is Hiring a Referral Management Center Registered Nurse Near Biloxi, MS
Registered NurseThe Referral Management Center (RMC) serves as the central clearinghouse for providers and patients needing information or help with referrals. Referral Management is a critical program supporting the patient-centered mission. This is a full-time position based at Keesler AFB, MS.We are looking for a Registered Nurse to:
- Review initial specialty care and deferred to network primary care referrals for administrative completeness
- Coordinate with specialty referral clinics.
- Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.
- Track initial specialty care and deferred to Network primary care referrals to include obtaining reports from MTF, ODCS, network, and non-network providers.
- Provide patient education regarding specialty care referral, procedures, labs, etc. to prepare the patient for their specialty care appointment/procedure.
- Facilitate professional and patient care activities.
- Conduct first level reviews for all referrals to specialty care.
- Identify cases that may benefit from alternative levels of care and involves the case manager as needed to provide direction in care management/coordination.
- Provide nursing consultation and patient education on specialty care and patient's diagnosis.
- Assist with CLR uploads as needed.
- Registered Nurse License: any U.S. state honored. active, unrestricted.
- Two (2) years of healthcare administrative experience in either an inpatient or outpatient care setting within the last three (3) years, highly preferred.
- Knowledge and skills to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care Guidelines.
- Working knowledge of APGs, DRGs, ICD-9, and CPT-4 coding.
- Working knowledge of TRICARE
- Excellent oral and written communication skills and interpersonal skills
- Working knowledge of computers (Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows).
- HIPAA knowledge a must.
- Ability to pass a background check.
Job Summary
JOB TYPE
Full Time
INDUSTRY
IT Outsourcing & Consulting
SALARY
$73k-92k (estimate)
POST DATE
04/17/2024
EXPIRATION DATE
06/15/2024
WEBSITE
reef-sys.com
HEADQUARTERS
CARY, NC
SIZE
50 - 100
FOUNDED
2008
CEO
RADWAN ROUZKY
REVENUE
$5M - $10M
INDUSTRY
IT Outsourcing & Consulting
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