Licensed Practical Nurse * Referral Management Center

Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team.

Decypher is seeking a Licensed Practical Nurse - Referral Management Center to support Naval Medical Center Camp Lejeune in Jacksonville, North Carolina. U.S. Citizenship is required.

Qualifications

• Degree/Education: Graduation from a State Board of Nursing approved LPN/LVN training program or completion of equivalent military training that permits sitting for the State licensure examination.
• Experience: Current experience requirement is one year in the last two years as a practical or vocational nurse.
• Licensure: Current, full, active and unrestricted license as a practical or vocational nurse.

At Decypher we believe that equal opportunity fuels innovation by using the strengths of individual differences. Therefore, we strive to provide a welcoming and inclusive work environment. Decypher is fully committed to a program of equal opportunity for all applicants and employees and will actively carry out all federal and state regulations and executive orders. We apply our equal opportunity policy to all employment decisions.

Responsibilities

• Reviews referrals for administrative, clinical completeness and appropriateness. Validates requested medical service, and authorizes surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations. Collaborates with TRICARE Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues or concerns.
• Schedules referral appointments in accordance with required Access to Care Standards within the direct care system or outside the MTF with network/non-network providers for 90% of all referrals.
• Provides timely, descriptive feedback regarding utilization review issues.
• Reviews and enters first right of refusal referrals into CHCS and database within one (1) business day of the date of the referral.
• Submits referrals to non-network providers to TRICARE Service Center (TSC) for processing.
• Receives and makes patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals.
• Tracks referral reports; obtain referral results within the required timelines and follow up with as necessary. Documents that paper referral results are properly filed in patient's health record.

This job description is not intended to be all inclusive. Therefore, the employee may be requested to perform other reasonable duties as assigned by the immediate supervisor or other management as required.

Note: This position is expected to be filled at a later date. Applications are still encouraged, and qualified candidates will be contacted when the hiring process begins.