Referral Management Specialist

2 weeks ago


Bethesda, Maryland, United States Zimmerman Associates Full time
Job Title: Referral Management Specialist

Zimmerman Associates, Inc. (ZAI) is seeking a Referral Management Specialist to support a government contract bid in the Bethesda, MD area.

This is an onsite employment opportunity, with consideration for teleworking upon customer approval.

Responsibilities:

  • Review referrals to ensure accuracy, completeness, and appropriateness
  • Collaborate with healthcare teams to ensure proper use of the Direct Care System and civilian network resources
  • Schedule patients timely, with the right provider, and at the designated place of care

Qualifications:

  • Minimum of an Associate's degree and 2 years' experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral
  • Knowledge of medical terminology and computer literacy to interpret and apply medical care criteria
  • Effective communication and people skills, with superior customer service skills
  • Excellent organizational skills, with ability to manage time effectively and prioritize tasks

Essential Tasks:

  • Review referrals to ensure accuracy, completeness, and appropriateness
  • Collaborate with healthcare teams to ensure proper use of the Direct Care System and civilian network resources
  • Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required timelines

Requirements:

  • Minimum of 2000 CLRs to be posted per month, with a maximum of 3000 CLRs available per month
  • Regularly review facilities' services, medical treatment capabilities, and capacity for assigned specialties/product lines
  • Proactively collaborate with Team Leads, Product Line Leaders, and other healthcare team members to address process issues or concerns

Working Conditions:

  • Onsite employment opportunity, with consideration for teleworking upon customer approval
  • Regularly review and process referrals, with a goal of reviewing 33,000 to 50,000 referrals per month

Benefits:

  • ZAI is an equal opportunity employer, committed to diversity and inclusion
  • Qualified applicants are considered for all positions applied for without regard to race, color, religion, sex, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, veteran status, or any other legally protected status


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