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Referral Management Health Care Coordinator
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Full-time
- Knowledge, skills and computer literacy to interpret and apply medical care criteria, such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs) or other evidence-base guidelines identified by the MHS.
- The Contractor must have a working knowledge of medical terminology, MHS, VDOD Sharing Program, TRICARE, HIPAA, release of medical information.
- Under the direction and guidance of product line nurse identifies required tests, labs, radiology studies and other pre-requisites specific to each assigned specialty/product line prior to dispositioning using CHCS, AHLTA, HAIMS, Essentris, Humana Government portal, and other electronic health records or databases.
- Demonstrates proficiency in utilizing CHCS, AHLTA, ESSENTRIS, CCS/CareRadius (RMS), MCSC
- Contractor’s portal, MHS GENESIS, and AVAYA systems.
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