Clinical Nursing Specialist
3 hours ago
Zimmerman Associates, Inc. (ZAI) is seeking a Clinical Nursing 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.
Role and Responsibilities:- Review referrals for suitability, administrative and clinical completeness, and required tests and pre-work for disposition per IRMAC guidelines.
- Collaborate with MCSC, Product Line Leaders, RM, Appointing Center(s), and other members of the healthcare team to address process issues or concerns.
- Ensure Consult processing is completed within established Access to Care guidelines to ensure patients are booked at the right time, with the right provider, at the right place of care.
- Review referrals within established guidelines from a market approach utilizing MHS-GENESIS Managed Care Support Contract Portal and other EHRs or databases as needed.
- Licensed Registered Nurse, possessing an unencumbered and active RN license from the State Board of Nursing and graduated from an accredited nursing program.
- Three years of clinical nursing experience is required, with RM and Utilization Management (UM) experience preferred.
- Full-time employment in a nursing field within the last 24 months is mandatory.
- 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 MHS.
- Review all details of referral for suitability, administrative and clinical completeness, and required tests and pre-work for disposition per IRMAC guidelines.
- Collaborate with Product Line leadership, clinic POCs in efforts to optimize direct care resources for high acuity, high-cost cases, or care for active-duty service members.
- Communicate with ordering providers/clinic team to clarify and/or seek information in efforts to process referrals per the guidelines established.
- Ability to utilize InterQual, Milliman Ambulatory Care Guidelines or other evidence-based guidelines identified by the MHS, DHA to perform medical necessary reviews.
- Ability to verify patients' eligibility in the DEERS and registration in GENESIS.
- Ability to obtain pertinent information from patients/callers and enter data in MHS-GENESIS, AHLTA, MHS GENESIS, Referral database, and other office automation software programs as appropriate.
ZAI 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.
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