Medical Referral Specialist

2 days ago


Bethesda, Maryland, United States Zimmerman Associates Full time
Job Summary
Zimmerman 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 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.

Responsibilities
- Facilitate referral reviews, collaborating with team leads, Product Line Leaders, Appointing Center(s), and other healthcare team members as necessary.
- Review referrals for administrative, clinical completeness, and appropriateness upon receipt, dispositioning within 24 hours from date referral was written.
- Collaborate with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison, and other healthcare team members as needed to address process issues or concerns.
- Routinely monitor and process referral management Genesis Work Lists to ensure consults are processed within established guidelines.
- Advise patients of their referral status, 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.

Requirements
- Minimum of an Associate's degree, current, active full and unrestricted License Practical Nurse Certification/Licensure from an approved National League of Nursing program.
- 2 years of clinical nursing experience.
- 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).
- Effective communication and people skills.
- Superior customer service skills.

Work Environment
This is an onsite employment opportunity, however, consideration will be provided for teleworking upon customer approval.

The candidate must be a U.S Citizenship required as well as ability to obtain a Public Trust Clearance.

We offer a competitive salary range of $65,000 - $80,000 per year, commensurate with experience.

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