The Referral Management (RM) Registered Nurse (RN) for Managed Care is assigned to the Chief Medical Executive at the Captain James A. Lovell Federal Health Care Center (FHCC) in North Chicago, Illinois. FHCC is a VA and DoD dually integrated healthcare center providing care services to Veterans, Active-Duty Military Personnel, and their beneficiaries, including outpatient pediatric services.

Duties

The Referral Management RN executes position responsibilities that demonstrate leadership, experience, and creative approaches in providing individualized care and promotes positive outcomes for TRICARE beneficiaries through collaborate and effective practices of ensuring appropriate medical resources. Utilization through a multidisciplinary team effort ensures beneficiaries receive timely, appropriate, and coordinated health services to maximize quality and cost-effective health outcomes available under all aspects of the Military Health System (MHS). The MHS includes but is not limited to TRICARE Prime, TRICARE Standard, TRICARE for Life, Temporary Disability Retired List, and Supplemental Health Care Programs. The Referral Management RN provides resources to Remote Active Duty Service Members, qualified Reservists, Persons with Disability, Foreign Nationals, Medicare, and other Health Insurance programs, each with separate eligibility requirements and regulatory provisions. Major Duties and Responsibilities Coordinates and manages all referrals for specialty care services received from internal and external providers for the Department of Defense (DOD) beneficiaries. Determines if beneficiaries meet eligibility requirements for available and covered services and/or benefits under TRICARE. Utilizes a variety of services and/or benefit options to ensure that the beneficiary is referred for appropriate services and identified needs according to eligibility and geographic location. Oversees and processes specialty referrals received daily via the Federal Electronic Health Records (FEHR), TRICARE contractor system, and Referral Management System (RMS). Communicates with referring providers via FEHR, e-mail, telephone, and/or in person to obtain information required to process specialty referral request. Develops processes to efficiently triage and process referrals for fitness for duty and medical board evaluations, follow-up care for Reserve Line of Duty (LOD) determinations, recruitment physicals, and out of the area care. Reviews referrals for active duty service members needing civilian medical care, researches and considers benefit coverage and eligibility prior to appointing a provider, and forwards to Managed Care Support Contractor (MCSC). Advises beneficiaries, providers and managers on available care options. Receives, responds to, and follows-up on numerous phone calls from other Military Treatment Facility (MTF) and network providers regarding referrals. Provides support to TRICARE contract staff, military units from other regions, and beneficiaries requesting information on referral processes and status updates. Resolves requests for assistance without delay. Serves as the point of contact for TRICARE contractors on specialty referral issues and resolves without delay. Establishes collegial relationships with other staff within the facility, the VISN, and the VA. Collaborates with other disciplines and caregivers, using the group process for decision-making in interdisciplinary problem solving for patients in Referral Management. Supports Nursing Service verbally and by example and implements nursing practice consistent with the mission, vision, and values of the James A. Lovell, Federal Health Care Center. Assists others in practicing the same. Promotes, creates, demonstrates, and ensures a culturally diverse workforce in which the values and needs of all individuals are respected. Provides leadership in developing and maintaining standards of care which contribute to safe, comprehensive, and quality services to patients receiving services. Evaluates the delivery of care using standards of care/practice, analyzes findings and various reports and recommends changes in practices. Facilitates QI processes at the unit and service level. Uses knowledge of mission, vision, and values to facilitate care and monitors quality improvements for improved outcomes. Describes and utilizes the continuous quality improvement process, roles, and responsibilities. VA offers a comprehensive total rewards package: VA Nurse Total Rewards Pay: Competitive salary, regular salary increases, potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave, 13 days of sick leave, 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday-Friday, 7:30am to 4:00pm cst Telework: Available Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not authorized. Permanent Change of Station (PCS): Not authorized. Financial Disclosure Report: Not required.

Requirements

Qualifications

Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Basic Requirements: United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English. Graduate of a school of professional nursing approved by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE). The approving official may authorize a waiver of the requirement for ACEN or CCNE accreditation of any degree in nursing provided the college or university has regional accreditation from an accrediting body recognized by the Department of Education at the time of the candidate's graduation and the composite qualifications of the applicant warrant such consideration. In cases of graduates of foreign schools of professional nursing, possession of current, full, active and unrestricted registration will meet the requirement of graduation from an approved school of professional nursing. OR The completion of coursework equivalent to a nursing degree in a MSN Bridge Program that qualifies for professional nursing registration constitutes the completion of an approved course of study of professional nursing. Students should submit the certificate of professional nursing to sit for the NCLEX to the VA along with a copy of the MSN transcript. (Reference VA Handbook 5005, Appendix G6) OR In cases of graduates of foreign schools of professional nursing, possession of a current, full, active and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing. Current, full, active, and unrestricted registration as a graduate professional nurse in a State, Territory or Commonwealth (i.e., Puerto Rico) of the United States, or the District of Columbia. Preferred Experience: Have a Bachelor of Science in Nursing or Bachelor's Degree in a healthcare related field; Have at least two (2) years of complex RN nursing practice; experience in medical-surgical, critical care, or oncological preferred; Have knowledge of and ability to use computer skills to enter patient data and to extract information and generate reports from sophisticated computer software packages; Have/maintain current certification in Basic Life Support (BLS); Be proficient in the written and spoken use of the English Language. Grade Determinations: The following criteria must be met in determining the grade assignment of candidates, and if appropriate, the level within a grade: Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required. Nurse I Level II - An ADN or Diploma in Nursing and approximately 1 year of nursing practice/experience; OR an ADN or Diploma in Nursing and a bachelor's degree in a related field with no additional nursing practice/experience; OR a Bachelor's of Science in Nursing (BSN) with no additional nursing practice/experience. Nurse I Level III - An ADN or Diploma in Nursing and approximately 2-3 years of nursing practice/experience; OR an ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 1-2 years of nursing practice/experience; OR a BSN with approximately 1-2 years of nursing practice/experience; OR a Master's degree in nursing (MSN) or related field with a BSN and no additional nursing practice/experience. Nurse II - A BSN with approximately 2-3 years of nursing practice/experience; OR ADN or Diploma in Nursing and a Bachelor's degree in a related field and approximately 2-3 years of nursing practice/experience; OR a Master's degree in nursing or related field with a BSN and approximately 1-2 years of nursing practice/experience; OR a Doctoral degree in nursing or meets basic requirements for appointment and has doctoral degree in a related field with no additional nursing practice/experience required. Nurse III - Master's degree in nursing or related field with BSN and approximately 2-3 years of nursing practice/experience; OR a Doctoral degree and approximately 2-3 years of nursing practice/experience. Note regarding MSN degrees: If your MSN was obtained via a Bridge Program that qualifies for professional nursing registration, a BSN is not required. Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6 Nurse Qualification Standard. This can be found in the local Human Resources Office. Working Conditions: To perform in a fully successful manner, the individual must have the physical ability to perform job-related duties which require the following: light lifting (under 15 pounds); light carrying (under 15 pounds); reaching above shoulder; use of fingers; both hands required; both legs required; walking (up to 1 hour); standing (up to 1 hour); prolonged sitting (up to 4 hours); near vision correctable at 13" to 16" to Jaeger 1 to 4; far vision correctable in one eye to 20/20 and to 20/40 in the other; and hearing (aid permitted). Administrative duties include word processing, computer keyboard typing, entering and retrieving database information, computer screen viewing, answering/placing telephone calls, filing, note taking. In addition, the following environmental factors apply, working closely with others and working alone. A health examination must be successfully completed prior to this assignment and periodically thereafter as required by the Occupational Health Clinic policy. There will be intermittent exposure to blood and body fluids.

Education

IMPORTANT: A transcript must be submitted with your application if you are basing all or part of your qualifications on education.

Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/.

IMPORTANT: If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html.

IMPORTANT: For foreign education equivalency the only certifying body the VA recognizes is CGFNS and its' subsidiary, International Consultants of Delaware (ICD). Without certification of BSN-equivalency, the VA can only consider the degree at the associates level and pay will be determined accordingly.

Contacts

• Address Captain James A Lovell Federal Health Care Center 3001 Green Bay Road North Chicago, IL 60064 US
• Name: Antionette Sneed-Clay
• Email: [email protected]