Goldbelt Glacier is accelerating healthcare delivery and providing superior force health readiness across the military, federal, and civilian landscapes. Goldbelt Glacier is committed to providing transformative and comprehensive health operational capabilities to support customers across scientific, clinical, technological, and program management areas.

Summary:

As a part of the Goldbelt Glacier Team, you will be supporting medical services for active-duty military personnel, their dependents, eligible DoD civilian employees, and other eligible beneficiaries designated by the Government. As a HealthCare Worker (HCW). 

Essential Job Functions:

• Assist in developing and refining referral management (RM) to support medical management initiatives at the military treatment facility (MTF). 
• Assess, monitor and evaluate and assist in processing referrals for authorization. The contractor shall review specialty care referrals for clinical appropriateness, covered benefit, and administrative and medical completeness following MTF, DHA, BUMED guidelines and TRICARE policy. 
• The HCW shall input and retrieve patient information for each referral, through the use of various computer systems include Electronic Health Record (EHR), Defense Enrollment Eligibility Reporting System (DEERS) and other work programs that are in use in the Referral Management Center.  
• Refer to a physician advisor for clinical review if the HCW and physician cannot reach an agreement on the processing of a referral within one business days. Timelines shall be monitored through computer reporting systems such as Electronic Health Record and TRICARE Reports. 
• Elevate referrals to the medical manager, utilization nurse, and physician advisor for higher level of review when there is uncertainty in medical necessity and covered benefit. All referrals for routine continental US care will be elevated to the medical manager and director of medical services. 
• Communicate between physician reviewer and the requesting provider in regard to preauthorization. 
• Submit monthly, quarterly, and yearly utilization reports using Electronic Health Record and TRICARE Reports. The HCW will report on referral trends, patterns or incidents of under- and/ over- utilization of resources, network leakage, purchased care costs, network care recapture, continuity of care, and customer satisfaction for all beneficiaries. The HCW will discuss patterns and trends with MTF providers and the Directorate of Healthcare Business leadership to educate and improve processes. The HCW shall present these reports to all medical staff with recommendations for efficient use of resources. 
• Evaluate monthly through prospective, concurrent, retrospective review, focused reviews, clinical pathways and clinical practice guidelines for performance outcomes of clinical care. The HCW will review ten defer to network consults per month to determine consult outcome and if clinical practice guidelines were met. If not met, the HCW will develop and implement a plan of action for consult management to ensure clinical practice guidelines are met. 
• Identify and communicate all adverse trends and referral management discrepancies in a written report via the chain of command and effectively communicate both verbally and in writing with the requesting physician(s) for clarification and correction. The report is to be submitted when trend/discrepancies identified. 
• Manage the referral processing center for all beneficiary categories (Active Duty, Active Duty Family Members, Retirees, and their family member, survivors, Department of Defense Civilians, Contractors) of patient clinical referrals and care authorizations to health care specialists in either the direct care or purchased care systems. 
• Provide departmental, directorate, and command performance improvement processes commensurate with this position. The HCW will be responsible for participating in monthly education programs, quality assurance functions and process action teams to improve the operations of the referral management center. 
• Referral management services will be performed in a managed care environment. The RN referral manager shall adhere to clinical practice guidelines, DHA policies, BUMED Referral Management Guidelines; Referral Management policies; TRICARE policies and procedures; and ICD and DRG codes. 
• The contractor shall participate in monthly in-service training for healthcare 
• practitioners and administrative staff on subjects of referral management and utilization management services. 
• Provide the MTF with a report on internal referral management bi-weekly using approved tools and electronic health record. This report will be disseminated to the medical staff and directorate of healthcare business leadership. The RN referral management will manage discrepancies and collaborate with clinic managers to ensure access to clinical care is delivered according to BUDMED, TRICARE, and DHA policies. 
• Provide education and training on the referral management process, specialty referral guidelines, and related policies to beneficiaries, providers, and host nation partners. 

Necessary Skills and Knowledge:

• Maintain a level of productivity comparable with that of other individuals performing similar services. 
• Adhere to and comply with the Department of the Navy, Bureau of Medicine and Surgery, and local instructions and notices in effect during the term of the contract. 
• Practice aseptic techniques as necessary; comply with infection control guidelines to include the proper handling, storage, and disposal of infectious wastes, and the use of universal precautions to prevent the spread of infection. 
• Function with an awareness and application of safety procedures. 
• Apply an awareness of legal issues in all aspects of patient care and strive to manage situations in a reduced risk manner. 
• Exercise awareness and sensitivity to patient/significant others' rights, as identified within the MTF. 
• Maintain an awareness of responsibility and accountability for own professional practice. 
• Maintain DoD email account as directed by government supervisor. 
• Exercise appropriate delegation of tasks and duties in the direction and coordination of health care team members, patient care, and clinic activities. 
• Each HCW providing service under this contract or resultant task orders shall undergo an orientation and shall complete mandatory Navy and DoD on-line training as required. 
• Be able to comply with all applicable Federal, State, and local laws, Department of Defense, Department of Navy, Bureau of Medicine and Surgery, and MTF instructions and policies. 
• Proficiency in Microsoft Office software applications including Word, Excel, Access, PowerPoint, and Outlook 

Minimum Qualifications:

• Possess and maintain a current certification and registration by the Pharmacy Technician Certification Board (PTCB). 
• HCW shall be in good standing, and under no restrictions, with the state licensure board in any state in which a license is held or has been held within the last 10 years. 
• HCW shall be in good standing and under no sanction or suspension by the Federal Government. 
• Possess and maintain current certification in either the American Heart Association BLS for Healthcare Providers or American Heart Association Healthcare Provider Course. 
• Able to read, write, speak, and understand the English language fluently and maintain good communication skills with patients and other health care personnel. 
• Ability to pass all background/suitability checks. 
• A valid driver's license; ability to travel locally as needed. 

Preferred Qualifications:

• A thorough understanding of the military lifestyle and experience working with military family members. 
• Working knowledge of relevant military, state, federal, and local laws and resources. 
• Highly developed written, oral, and presentation communication skills.

Pay and Benefits
At Goldbelt, we value and reward our team's dedication and hard work. We provide a competitive base salary commensurate with your qualifications and experience. As an employee, you'll enjoy a comprehensive benefits package, including medical, dental, and vision insurance, a 401(k) plan with company matching, tax-deferred savings options, supplementary benefits, paid time off, and professional development opportunities.