Overview: Nurse Reviewer- RNAt iCallidus, you will be invited to participate in learning opportunities to grow your career, encouraged to foster a work-life balance and rewarded for your meaningful contributions. We serve as a key partner to government agencies using leading edge technologies and strategies to re-invent the way things get done. Our culture is built on inclusion, collaboration, high-performance and opportunity. We have exciting opportunities for you to join our diverse group of innovators. Responsibilities: Essential Job Functions/ResponsibilitiesProvide utilization management activities in the Referral Management Center.Review referrals for administrative, clinical completeness and appropriateness. Validate requested medical service, and authorizes surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations. Collaborates with DHA 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 with network/non-network providers. Ensures appointing is done within the Access to Care standards for 90% of all referrals.Coordinate with specialty referral clinics (internal or external) to obtain special patient instructions and/or tests required prior to appointment. Provides pre-appointment instructions to patients as well as the details regarding their referral appointment (ie, date/time, provider, and location). Ensures patients receive necessary documentation appropriate for the referred medical care visit.Locate referral requests and ensures appropriate documents are available prior to all specialty appointments. Prints diagnostic reports and/or treatment profiles, as necessary.Verify eligibility of beneficiaries using Defense Eligibility Enrollment Reporting System (DEERS).Facilitate referral activities by participation in multidisciplinary team activities. Initiates/coordinate communication between beneficiaries, team members, internal staff and providers, network/outside providers, and ancillary health care workers. Provides timely, descriptive feedback regarding utilization review issues.Review and enter first right of refusal referrals into CHCS and database within one (1) business day of the date of the referral.Interface with the Managed Care Support Contractor (MCSC) and multidisciplinary personnel as need to ensure appropriateness of referrals. Submits referrals to non-network providers to DHA Service Center (TSC) for medical necessity/appropriateness reviewPerform data collection and review to identify areas requiring intensive management. Refers to case management officials if needed.Receive and make patient telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors referral management CHCS queue to ensure patients are being called that do not utilize the RMC walk-in service.Contact patients in event referral requests are invalid, disapproved by second level review/MCSC and reschedules patients as soon as possible or instructs patients of other health care options.Receive and appropriately forwards clinical phone consult requests from patients.Advise patients of what their referral/health treatment options are as related to their eligibility per beneficiary status and covered benefits. This includes eligibility for travel benefits.Coordinate with Aerovac units to make travel arrangements with the Global Patient Movement Requirements Center using the TRANSCOM Regulating and Command and Control Evacuation System as indicated. Ensures Aerovac personnel arrange travel orders and non-medical attendants as required for the patient and the patient is informed.Advise online-of-Duty issues.Obtain pertinent information from patients/callers, referrals, physician, or other officials. Enters data in CHCS, AHLTA, MHS GENESIS, Referral database, and other office automation software programs as appropriate.Track referral reports after appointments are kept. Ensures that results from other MTFs and from network/non-network providers are returned to the referring provider and to the medical record within required timelines and follow up with, as necessary. Documents that paper referral results are properly filed in patients health record.Perform referral review duties under the direction/guidance of the product line nurse(s), IRMAC Referral Management Leadership Qualifications: Skills and Requirements:Bachelors Degree in Nursing from accredited school.Licensed RN - current valid nursing license.Military Medical Facility experience preferred.Ability to work Monday Friday 7:30 AM 4:00 PM at Off-site Walter Reed locationEEO StatementiCallidus is an Equal Opportunity/Affirmative Action Employer. We do not unlawfully discriminate on the basis of race, color, religion, age, sex, creed, national origin, ancestry, citizenship status, marital or domestic or civil union status, familial status, affectional or sexual orientation, gender identity or expression, genetics, disability, military eligibility or veteran status, or any other protected status.