Referral Management Licensed Practical Nurse (LPN) — Columbus, MS

You'll use your clinical nursing experience to coordinate specialty care referrals that help military beneficiaries access timely, appropriate healthcare services. Working within a Referral Management Center (RMC), you'll review referrals, educate patients, collaborate with providers, and help ensure referrals move efficiently from initiation through completion while supporting continuity of care.

Schedule: Full-Time | Monday-Friday | Days (7:30 AM-4:30 PM) | Federal Holidays & Scheduled Down Days Off

Key Responsibilities

• Review, coordinate, and manage specialty care referrals from initiation through completion while ensuring compliance with TRICARE requirements, referral management business rules, and established timeliness standards.
• Assess referral completeness, verify patient eligibility and demographic information, coordinate with referring providers when additional clinical information is needed, and schedule specialty appointments within established access-to-care guidelines.
• Educate patients regarding referral processes, specialty appointments, required testing, procedures, and pre-appointment instructions while serving as a clinical resource for referral-related questions.
• Collaborate with providers, case managers, utilization management staff, specialty clinics, and network partners to facilitate appropriate referrals, resolve referral issues, and support continuity of care.
• Monitor referral activity, obtain and process specialty care documentation, maintain accurate referral records, generate referral-related reports, and help ensure referral documentation is returned to the patient's medical record within established timelines.
• Perform first-level clinical reviews of specialty referrals, identify patients who may benefit from additional care coordination, participate in quality improvement activities, and contribute to ongoing Referral Management Center operations.

Requirements

• Graduate of an accredited practical or vocational nursing program.
• Current, unrestricted Licensed Practical Nurse (LPN) license in good standing and current BLS certification through the American Heart Association or American Red Cross.
• 2+ years of broad-based clinical nursing experience in an inpatient or outpatient setting within the last three (3) years.
• Experience interpreting and applying medical necessity criteria or utilization review guidelines, such as InterQual or Milliman Ambulatory Care Guidelines.
• Working knowledge of referral management processes, electronic medical systems, Microsoft Office applications, customer service principles, and professional healthcare communication.

Preferred

• Experience supporting referral management, utilization management, case management, or care coordination within a military, government-supported, or integrated healthcare environment.
• Experience working with TRICARE, CHCS, AHLTA, HAIMS, RMS, DEERS, or similar healthcare information systems.

ll your information will be kept confidential according to EEO guidelines.

Privacy Disclaimer: Policy Link

Compensation Disclaimer:

Benefits Language (FTE roles):