Licensed Practical Nurse (LPN)

GCP-Inc; Palo Alto (CA); On-site; USD 50,000 - 65,000; Full time

Job summary

GCP-Inc in Palo Alto is seeking a Licensed Practical Nurse for their Referral Management Center. The primary role involves reviewing and scheduling patient referrals, ensuring compliance with medical service standards.

Successful candidates will hold a certificate from an approved nursing program and possess at least one year of nursing experience within the last two years. An active, unrestricted nursing license is also mandatory.

Qualifications

• Graduation from a State Board of Nursing approved LPN/LVN training program.
• One year of experience in the last two years as a practical or vocational nurse.
• Current, active, unrestricted license as a practical or vocational nurse.

Responsibilities

• Review referrals for completeness and appropriateness.
• Schedule referral appointments as per access standards.
• Track referral results and ensure documentation is filed.

Skills

Validation of medical services

Communication skills

Experience in medical referrals

Education

Certificate from a State Board of Nursing approved program

Job description

Licensed Practical Nurse – Referral Management Center

Minimum Qualifications

• Degree: Certificate.
• 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 licensee exam.
• Experience: Current experience required is one year in the last two years as a practical or vocational nurse.
• License: Current, full, active and unrestricted license as a practical or vocational nurse.

Core Duties

• Review referrals for administrative, clinical completeness and appropriateness.
• Validate required medical services, authorize surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations; collaborate with TRICARE regional Office Clinical Liaison Nurse and MTF.
• Liaison to address any process issues or concerns.
• Schedule referral appointments in accordance with required Access to Care Standards within the direct care system or outside the MTF within network/non-network providers for 90% of all referrals.
• Provide timely, descriptive feedback regarding utilization review issues.
• Review and enter first right of refusal referral into CHCS and database within one (1) business day of the date of the referral.
• Submit referrals to non-network providers to TRICARE Service Center (TSC) for processing.
• Receive and make patient telephone calls and computer/ written correspondence regarding specialty clinic appointments and referrals.
• Track referral reports; obtain referral results within the required timelines and follow up as necessary; document that paper referral results are properly filed in patient’s health record.