Licensed Practical Nurse; LPN – Robins AFB, GA

Overview

Reef Systems has an immediate need for a Licensed Practical Nurse (LPN) to support the Air Force Medical Service (AFMS) mission at the Referral Management Center (RMC) located at Robins AFB, GA. This is a full-time, on-site position.

Background:
The Air Force Medical Service (AFMS) operates a worldwide healthcare system to deliver medical services for more than 2.63 million eligible beneficiaries, including active duty, family members, and retirees, during peacetime and wartime. The RMC coordinates referrals, advises patients of benefits, and ensures referrals are accurate, tracked to closure, and returned to the patient’s medical record. The number of referrals varies by patient population, illness severity, local networks, and referral patterns.

Scope:
The contractor shall support AFMS in staffing and managing RMCs at the MTFs, serving as the one-stop shop for referrals from initiation to delivery of a HIPAA-compliant report to the MTF. The RMC acts as the central clearing house for information and support related to referrals, supporting the patient-centered medical home model and the MTF’s clinical capabilities and expeditionary medicine currency platforms.

Referral Management Center (RMC) Operations:

• Operate the RMC at the MTFs listed within Appendix A and support RMC operations and referral management services during normal MTF business hours for telephonic, electronic, and in-person access.
• Process and review referrals in government information systems including MHS GENESIS, CHCS, MCSC referral systems, AHLTA, HAIMS, RMS, and ICD-B programs.

Referral Management

Activities:

• Accurately refer patients to subsequent care using current MTF capabilities, ATC standards, and RMC business rules as outlined in AFI 44-176 and AFMS RMC Guide.
• Initiate, follow, manage, and close referrals within timeliness standards identified in TRICARE Operations Manual and government policies.
• Provide patient education about specialty care referrals, procedures, and labs; educate MTF clinical personnel about referral processes and timelines (semi-annually).
• Identify and notify the Government MTF case manager, UM nurse, or PCM team as appropriate for care management/coordination.
• Support recapture initiatives by sustaining current MTF Specialty Clinic Booking Guidance, MTF Capabilities Report, and related MOUs; participate in inspections as requested.

Referral Review / Appointing Function:

• Review initial specialty care and network referrals for administrative completeness and benefit coverage.
• Coordinate with referring providers for additional information; verify CHCS/DEERS registration and update demographics as needed.
• Determine patient eligibility and schedule appointments to MTF or Other Direct Care System (ODCS); defer to network if needed.
• Assist with ROFR determinations, document appointments in AFMS systems, and process ROFRs within specified TRICARE times.
• Accept/decline ROFRs and outside referral requests within defined time frames; return ROFR results to the referring provider within required timelines.
• Transmit referrals through RMS to MCSC and manage invalid/ disapproved referrals with rescheduling or alternative options within two business days.
• Manage pre-appointment instructions, care episode information, and communications to help locate/referral details.
• Assist with medical documentation requests and ensure timely submission to specialists; handle STAT/ASAP referrals as required.

Referral Tracking Function:

• Track initial specialty and network referrals, retrieve CLRs from MTF/ODCS/non-network providers, and ensure results are returned to the originating provider/PCM.
• Retrieve CLRs within 180 calendar days; escalate as needed; import/scan CLRs into the patient’s medical record within three business days of receipt and return results to the referring provider/PCM within three business days.
• Provide ongoing follow-up on incomplete CLR referrals and supply monthly lists of referred patients who have not scheduled initial appointments.
• Prepare referral management data reports/metrics; ensure accuracy within three business days and use data to support recapture…