RieLes Group a government support services provider, is currently seeking Registered Nursesto support the Integrated Referral Management and Appointing Centers located at Eglin AFB.

• Provide Referral Management (RM) activities including timely processing of Right of First Refusal (ROFR) requests & screening specialty care referrals
• Conduct reviews for medical necessity, preauthorization, medical appeals, collection, and recovery from insurance carriers
• Comply with Referral and Authorization Business rules, tracking, accounting, and resulting in referrals

• Must have valid unrestricted Nursing License
• Minimum of two (2) years broad-based clinical nursing experience in either inpatient or outpatient care setting within the last three (3) years
•  Must have 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