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8-koi, Inc. Registered Nurse in MIDDLESEX, Massachusetts

Registered Nurse

Summary

Title: Registered Nurse

ID: 5466

Department: Healthcare

Location: MIDDLESEX, MA

Description

Job purpose

To provide assistance at the Referral Management Service Center with primary care and specialty care services in a patient-centered environment to active-duty service members and their families for 8-koi; a diverse Florida based service and consulting company that has been providing outstanding results for our clients for over 12-years. Position is contingent upon contract award.

Duties and responsibilities

  • Review initial specialty care and deferred to network primary care referrals for administrative completeness.

  • Submit referrals to the appropriate reviewer when required for medical necessity and appropriateness review.

  • Track initial specialty care deferred to network primary care referrals to include obtaining reports from MTF, network and non-network providers.

  • Keep abreast of facilities’ services and medical treatment capabilities.

  • Provide patient education on specialty care referral, procedures, and labs to prepare the patient for their appointment or procedure.

  • Facilitate professional and patient care activities.

  • Provide patient consultation and patient education on specialty care and patient’s diagnosis.

  • Ability to interpret and apply medical care criteria, such as InterQual or Milliman Ambulatory Care guidelines.

  • Identify cases that may benefit from alternative levels of care and involves the case managers as needed to provide direction in care management/coordination.

  • General medical ethics, telephone etiquette, and customer service skill required.

Qualifications

  • Graduate from an accredited Nursing program.

  • Current, unrestricted, active RN licensure from any US state

  • Min of 2 years broad-based clinical nursing experience in either inpatient or outpatient care setting within the last 3 years.

  • Basic Life Support (BLS) certification with the American Heart Association or American Red Cross CPR/BLS.

  • Skilled in Word, Excel, and other Microsoft Office software programs.

  • Knowledge of TRICARE preferred

  • HIPAA Knowledge required

Working conditions

Working conditions are within a normal office environment.

Physical requirements

Normal office environment mobility; sitting, walking, bending, stooping, standing, lifting a maximum of 25 pounds (greater than 25 pounds requires a two-person lift), turning, pushing. Normal office dexterity, to include; reaching, handling, grasping, to include typing/keyboard, and phone use.

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