Registered Nurse at Referral Management Center

Key Duties: Coordinate discharge requirements, including DME, Home Health Care, community services, specialty referrals, medications, and follow-up appointments. Ensure patients and caregivers receive appropriate discharge instructions and post-discharge resources. Coordinate inpatient transfers and continuity of care between facilities. Work with TRICARE MCSC and third-party payers to obtain authorization for post-discharge needs. Verify insurance benefits and assist providers with appropriate referrals and services. Educate patients/families about skilled nursing facilities, group homes, community resources, and other appropriate care options. Educate providers and staff regarding discharge planning and interfacility transfers. Apply knowledge of safe discharge, medical necessity, utilization review, InterQual/Milliman, EMTALA and COBRA requirements. Analyze treatment plans for appropriateness and support cost-effective patient care. Participate in committees, process-improvement activities, staff education, and orientation. If not fully utilized at NLVVAMC, provide nursing support in the MOMMC Emergency Department or backup support for House Supervisors/Discharge Planners.

Degree/Education: Bachelor of Science in Nursing (BSN) from a nursing program accredited by a nationally recognized accrediting agency.

Experience: Minimum 5 years total nursing experience, with the most recent 3 years in direct patient care in a hospital as a Discharge Planner, Case Manager, Nurse Navigator, House Supervisor, or equivalent.

Licensure: Current, full, active, and unrestricted RN license in an authorized U.S. jurisdiction. Knowledge: Strong understanding of discharge planning, utilization management, medical necessity, TRICARE, Medicare, Medicaid, VA/private insurance, third-party collections, InterQual/Milliman criteria, EMTALA/COBRA, and healthcare reimbursement processes.

Schedule: This is a hybrid role between NLVVAMC and MOMMC. The workweek runs Sunday through Saturday with coverage scheduled according to mission requirements 24 hours a day. Shifts may be 4, 8, 10, or 12 hours, not exceeding 80 hours per two-week period. No on-call.

Work Environment: This is a fast-paced hospital-based care transition and referral management position working between a military medical center and VA medical center. The RN spends significant time coordinating discharges, referrals, transfers, insurance authorizations, and follow-up care while communicating with patients, families, physicians, nurses, case managers, social workers, and insurance organizations. Health & Other Requirements: Must meet all DHA/MTF occupational health, immunization, credentialing, and security/access requirements and maintain required RN licensure and certifications. Must comply with infection control, patient safety, privacy, and facility policies at both MOMMC and NLVVAMC.

Compensation: $60.00 - $62.00 per hour. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.