Registered Nurse – Navigator

The role

The Registered Nurse – Navigator will act as clinical liaison between the 96th Medical Group and the Eglin Community-Based Outpatient Clinic. The role coordinates referrals, patient transfers, discharge planning and related clinical and administrative work.

What you will do

• Serve as primary clinical liaison between the 96th Medical Group and the Eglin Community-Based Outpatient Clinic.
• Coordinate VA-to-DoD patient transfers, emergency department transfers, inpatient placements and outpatient referrals.
• Support safe and timely discharge planning, including equipment, home health, specialty referrals, follow-up and community resources.
• Screen and process specialty care referrals, authorizations and Right of First Refusal (ROFR) requests.
• Conduct medical necessity, preauthorization, medical appeal, utilization review and insurance-related activities.
• Coordinate with VA providers, physicians, specialists, utilization management, case management and social work staff.
• Apply InterQual and Milliman guidelines as appropriate.
• Monitor admission appropriateness, length of stay and discharge criteria to reduce avoidable delays.
• Educate patients, families and staff on discharge planning, referrals, transfers and resources.
• Maintain accurate documentation in MHS GENESIS and authorized VA systems.

Required qualifications

• U.S. citizenship required.
• Associate Degree in Nursing or Bachelor of Science in Nursing from an ACEN or CCNE accredited program.
• Current Basic Life Support (BLS) certification.
• Current, active, valid and unrestricted Registered Nurse license from a U.S. state, territory or D.C.
• Minimum of three years of clinical nursing experience.
• At least one year within the last two years as an RN in inpatient care, care coordination, discharge planning or case management.
• Extensive knowledge of the Military Health System or Veterans Health Administration.
• Knowledge of TRICARE concepts, referral management, discharge planning and care coordination.
• Working knowledge of medical necessity, utilization review, insurance processes and reimbursement.
• Knowledge of EMTALA and related emergency transfer and discharge requirements.
• Strong written, verbal, organizational and problem-solving skills.
• Proficiency with computer applications and electronic healthcare information systems.

Benefits

• Comprehensive medical, dental and vision coverage.
• Flexible Spending Account for healthcare and dependent care.
• Health Savings Account with high deductible medical plan.
• Retirement 401(k) with employer match.
• Open leave policy and paid holidays.
• Tuition reimbursement.
• Transportation expense account.
• Employee assistance program.
• Eligibility may vary by employment classification and contract requirements.

Before you apply

• U.S. citizenship is required for this contract position.
• Current BLS certification is required under contract terms.
• On-call rotation includes weekend, holiday and family day coverage.

About the company

The Copper River Family of Companies is owned by the Native Village of Eyak, a federally recognized Alaska Native Tribe. Its companies deliver complementary solutions and services and participate in the SBA 8(a) Business Development Program.