Licensed Practical Nurse Referral Specialist

1 day ago

Bethesda, Maryland, United States Zimmerman Associates Full time
Job Title: Licensed Practical Nurse Referral Specialist

Zimmerman Associates, Inc. (ZAI) is seeking a Licensed Practical Nurse Referral Specialist to support a government contract bid in the Bethesda, MD area. This is an onsite employment opportunity, with consideration for teleworking after 120 days onsite.

Role and Responsibilities:
  • Review referrals for appropriateness, administrative and clinical completeness, and compliance with Specialty Referral Guidelines.
  • Collaborate with team leads, product line leaders, and healthcare teams to address process issues and concerns.
  • Ensure Consult processing is completed within established Access to Care guidelines.
Qualifications and Skills:
  • Associate's degree and 2 years' experience in a MHS referral management center or clinic.
  • Licensed Practical Nurse Certification/Licensure from an approved National League of Nursing Program.
  • LPNs possess an unencumbered and active license to practice nursing in accordance with the State.
  • Two years of clinical nursing experience is required.
  • Knowledge of medical care criteria, such as InterQual, Milliman Ambulatory Care Guidelines, and Specialty Referral Guidelines.
  • Proficient in medical terminology, MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information.
Essential Tasks:
  • Review referrals for appropriateness, administrative and clinical completeness, and Specialty Referral Guideline compliance.
  • Complete referral review process upon receipt of referral.
  • Regularly review facilities' services, medical treatment capabilities, and capacity for assigned Product Lines/Specialties.
Requirements:
  • Accurately process referrals per guidelines established from the order date or date consult was directed to queues managed by IRMAC.
  • Enter/process/tracks/closes the ROFR referrals per guidelines established.
  • Receive and enter ROFR referrals in MHS-GENESIS from the MCSC's portal for assigned specialties/product lines.
Benefits:
  • Competitive salary and benefits package.
  • Opportunity to work with a dynamic team in a fast-paced environment.
  • Professional development and growth opportunities.

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