LPN Referral Reviewers

2 weeks ago

Bethesda, United States Ivyhill Technologies Full time

Ivyhill is currently seeking to hire LPN Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network. 

LPN Referral Reviewers will be responsible for facilitating centralized product line and specialty referrals for Active-Duty Service Members and Tricare Prime beneficiaries enrolled to a Military Treatment Facility (MTF) in the National Capital Region.

This is an onsite employment opportunity.  However, consideration will be provided for teleworking upon customer's approval.

Duties and Responsibilities

  1. Perform referral review duties, collaborating with team leads, Product Line Leaders, Appointing Center(s) and other members of the healthcare team and MTF points of contact as necessary. Reviews all referrals for administrative, clinical completeness and appropriateness upon receipt, dispositioning the referral within 24 hours from the date referral was written. Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to address any process issues or concerns, to ensure proper use of Direct Care system and civilian network resources, and to ensure that patients are booked at the right time, with the right provider, at the right place.
  2. Receives and places telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors and processes referral management Genesis Work Lists to ensure consults are being processed within the established guidelines.
  3. Advises patients of their referral status. This may include providing references for benefit counseling assistance and/or patient advocacy. Reschedule/instruct patients of other health care options within 3 days of notification of disapproved referral or invalid referral. Advises of Line-of-Duty issues as it relates to referral management.
  4. Receives and enters ROFR referrals in MHS-GENESIS from the MCSC’s portal for assigned specialties/product lines. Adheres to the defined timelines for response established by MHS, IRMAC standard operating procedures. Identifies and resolves ROFR issues in accordance with NCR Business Rules. Reports concerns related to the ROFR referral process to team lead as needed.
  5. Completes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines.
  6. Verifies patients' eligibility in MHS-GENESIS. If a patient is not showing as registered in MHS Genesis and eligible for care, the contact information for DEERS, the Managed Care Contractor for Tricare and the Benefits Counseling Assistance Coordinator is to be provided to patient. 
  7. Provides recommendations and/or assistance to staff, patients, and other members of the healthcare team when providing guidance regarding access to care options related to patient eligibility and beneficiary status.
  8. Advises patients of their referral/health treatment options and provides resources to address concerns related to Tricare benefits.
  9. Document in MHS-GENESIS, explaining appropriate options to patients when they refuse appointments within access to care (i.e., point of service, Tricare Select, be connected to Beneficiary Counselor and Assistance Coordinator).
  10. Contacts product line nurse/clinic when appropriate for accommodation of highly valuable cases.
  11. Interfaces with the MCSC and multidisciplinary personnel as needed to ensure appropriateness of referrals. Submits referrals to non-network providers to TRICARE Service Center for medical necessity/appropriateness review.
  12. Routinely monitors referral management voicemail to ensure patient calls are returned within the guidelines established.
  13. Provides information about EPRO to requestors outside the NCR requesting care within the NCR.
  14. Assists Medicare beneficiaries in coordinating their medical care within the Direct Care System.
  15. Closes unused referrals as directed by DHA IPM, NCR MD policies and notifies ordering provider accordingly.
  16. Orients and trains new IRMAC staff in the referral processes and timelines.
  17. Other duties as assigned.

Requirements

Qualified candidates must have a minimum of an Associate’s Degree, current, active full and unrestricted License Practical Nurse Certification/Licensure from an approved National League of Nursing program and 2 years of clinical nursing experience.  Additionally, qualified candidates must:

  1. Be a U.S. Citizen.
  2. Have 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-based guidelines identified by the Military Health System (MHS).
  3. Have knowledge of medical terminology with an ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, release of medical information.
  4. Have effective communication and people skills.
  5. Have the ability to provide superior customer service skills.
  6. Have demonstrated knowledge and understanding of Access to Care Standards within the Direct Care System.
  7. Have the ability to pay strict attention to detail and the appropriate use of deferral codes.
  8. Have excellent organizational skills, i.e., ability to manage time effectively, prioritize tasks, set goals, and implement plans for achieving those goals.
  9. Have knowledge of Microsoft Suite of Products, including Word, Excel, PowerPoint, Access, Outlook (email), and the Internet.

Benefits

Ivyhill has a competitive benefits program which includes medical, dental and vision; Life and AD&D insurance; Short- and Long-Term Disability; supplemental Life insurance and a 401(k) Plan.

Ivyhill is an equal opportunity employer. In compliance with Federal and State Equal Opportunity Laws, qualified applicants are considered for all positions applied for without regard to race, color, religion, sex (including pregnancy and gender identity) , national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status or any other legally protected status.

  • Referral Management

    4 weeks ago

    Bethesda, United States Zimmerman Associates, Inc Full time

    Zimmerman Associates, Inc. (ZAI) is currently seeking to hire several Referral Management (Non-Nurse) Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health...

  • Licensed Practical Nurse Referral Reviewer

    1 month ago

    Bethesda, United States Zimmerman Associates, Inc Full time

    Zimmerman Associates, Inc. (ZAI) is currently seeking to hire Licensed Practical Nurse Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health...

  • Licensed Practical Nurse Referral Reviewer

    2 weeks ago

    Bethesda, United States Zimmerman Associates, Inc Full time

    Zimmerman Associates, Inc. (ZAI) is currently seeking to hire Licensed Practical Nurse Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health...

  • Licensed Practical Nurse Referral Reviewer

    15 hours ago

    Bethesda, United States Zimmerman Associates, Inc Full time

    Zimmerman Associates, Inc. (ZAI) is currently seeking to hire Licensed Practical Nurse Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health...

  • Referral Management Coordinator

    1 week ago

    Bethesda, Maryland, United States Ivyhill Technologies Full time

    Job SummaryIvyhill Technologies seeks a highly skilled Referral Management Reviewer to join our team. In this role, you will be responsible for performing referral reviews, seeking guidance from product line nurses as needed, and collaborating with healthcare teams to ensure proper use of the Direct Care system and civilian network resources.Key...

  • Nurse Referral Specialist

    1 week ago

    Bethesda, Maryland, United States Zimmerman Associates Full time

    About the RoleZimmerman Associates, Inc. is seeking a skilled Nurse Referral Specialist to join its team in providing exceptional healthcare navigation services.Job DescriptionThe ideal candidate will be responsible for coordinating referrals, ensuring timely reviews and processing, and collaborating with various stakeholders to deliver high-quality care.Key...

  • Referral Management Coordinator

    1 week ago

    Bethesda, Maryland, United States Zimmerman Associates, Inc Full time

    Zimmerman Associates, Inc. is a leading provider of healthcare services, seeking highly skilled professionals to join our team as Referral Management Coordinators.Job Summary:We are looking for individuals with a strong background in utilization review and management to facilitate centralized product line and specialty referrals for Active-Duty Service...

  • Licensed Practical Nurse Referral Coordinator

    1 week ago

    Bethesda, Maryland, United States Zimmerman Associates Full time

    About the RoleWe are seeking a skilled Licensed Practical Nurse to join our team as a Referral Reviewer. In this role, you will play a vital part in ensuring seamless coordination of referrals for Active-Duty Service Members and Tricare Prime beneficiaries.As a Referral Reviewer, you will work closely with team leads, Product Line Leaders, Appointing...

  • Medical Referral Specialist

    4 days ago

    Bethesda, Maryland, United States Zimmerman Associates Full time

    Job SummaryZimmerman Associates, Inc. (ZAI) is a leading provider of referral management services for the Defense Health Network. We are seeking highly skilled Medical Referral Specialists to support our contract with the Integrated Referral Management and Appointing Center (IRMAC).In this role, you will play a critical part in facilitating centralized...

  • Travel Radiology Technologist Specialist

    1 week ago

    Bethesda, Maryland, United States Prime Time Healthcare Full time

    We are seeking a highly skilled Travel Radiology Technologist to join our team in Bethesda, Maryland. This is a 12-week assignment with a competitive salary of $2,300 per week.About the Role:Radiology TechnologistAs a Travel Radiology Technologist, you will be responsible for performing imaging procedures, maintaining equipment, and ensuring patient comfort...

  • Radiology Technologist in Bethesda, Maryland Opportunity

    1 week ago

    Bethesda, Maryland, United States Prime Time Healthcare Full time

    Prime Time Healthcare is a leading provider of traveling healthcare professionals nationwide. Our agency specializes in the placement of RNs, LPNs, CNAs, and Allied Health professionals.Estimated Salary: $29,600 for 12 weeksWe are currently seeking a skilled Radiology Technologist to join our team on a travel assignment in Bethesda, Maryland. This...

  • Medical Nurse

    1 week ago

    Bethesda, Maryland, United States Johns Hopkins HealthCare Full time

    At Johns Hopkins HealthCare, we're seeking an experienced LPN to join our Adult Medical team in Bethesda, Maryland. This is a full-time position with benefits, offering a competitive salary range of $29.76-$46.13 per hour, commensurate with equity and experience.About UsWe're a community-based hospital serving Montgomery County and the surrounding area for...

  • Registered Nurse

    2 weeks ago

    Bethesda, United States Ivyhill Technologies Full time

    Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.  Registered Nurse will have...

  • Registered Nurse

    1 month ago

    Bethesda, United States Zimmerman Associates Full time

    Zimmerman Associates, Inc. (ZAI) is currently seeking to hire several Registered Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network....

  • LPN or RN

    2 weeks ago

    Bethesda, United States Montcare Bethesda Full time

    *$5,000.00 Sign On Bonus!!!*Join our wonderful team as a *Registered Nurse (RN) today!**Montcare at Bethesda *is an exceptional team-oriented company hiring *Registered Nurses (RN)!* We provide our staff with the resources, tools, and training needed to succeed and grow in their current and desired future positions. We pride ourselves on our caring and...

  • LPN or RN

    1 week ago

    Bethesda, United States Montcare Bethesda Full time $37 - $41

    *$5,000.00 Sign On Bonus!!!*Have you got what it takes to succeed The following information should be read carefully by all candidates.Join our wonderful team as a *Registered Nurse (RN) today!**Montcare at Bethesda *is an exceptional team-oriented company hiring *Registered Nurses (RN)!* We provide our staff with the resources, tools, and training needed to...

  • Patient Access Representative

    1 week ago

    Bethesda, Maryland, United States Ivyhill Technologies Full time

    About the Role:We are seeking an experienced Patient Access Representative to join our team at Ivyhill Technologies. In this role, you will be responsible for coordinating patient access to medical services, ensuring that patients receive timely and efficient care.Key Responsibilities:Schedule appointments for patients seeking medical services, utilizing the...

  • Call Center Agents

    4 weeks ago

    Bethesda, United States Ivyhill Technologies Full time

    Ivyhill is currently seeking to hire Call Center Agents to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management. Call Center Agents will be responsible for coordinating healthcare appointments for primary care and...

  • Team Member Services Manager

    24 hours ago

    Bethesda, United States Retirement Living Full time

    Team Member Services Manager Company - The Kensington Bethesda 5485 Westbard Ave, Bethesda, MD 20816, USA Compensation Starting at $82,000 Employment Type Full-Time Start Date 11/01/2023 Why Kensington Senior Living? Because Our Promise to love and care for your family as we do our own. These are not just words – but something all of us at Kensington...

  • Medical Oncology Specialist

    1 week ago

    Bethesda, Maryland, United States Next GenHealth Staffing Full time

    About the RoleWe are seeking a highly skilled Medical Oncology Specialist to join our team at Next GenHealth Staffing.Job OverviewThis is a full-time position, requiring a minimum of 5 years experience as an APRN or PA, specifically in Oncology. The successful candidate will be responsible for providing direct diagnostic and therapeutic patient care, in...