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Registered Nurse
2 months ago
Zimmerman Associates, Inc. is seeking a highly skilled Registered Nurse (Non-Practicing) to support a government contract bid in the healthcare industry. As a Referral Management Specialist, you will be responsible for reviewing referrals, managing referrals, and ensuring timely access to care for patients.
Key Responsibilities- Referral Management: Review referrals for suitability, administrative and clinical completeness, and required tests and pre-work for disposition per IRMAC guidelines.
- Access to Care: Ensure Consult processing is completed within the established Access to Care guidelines to ensure patients are booked at the right time, with the right provider, at the right place of care.
- Referral Review Tools: Develop, maintain, and update as needed, referral review tools to ensure timely and efficient review of referrals.
- Deferral Process: Understand the deferral process (when to defer for distance, capacity, capability, second opinion, command directed, continuity of care) and utilize deferral codes appropriately.
- Eligibility Verification: Verify patients' eligibility in the DEERS and registration in GENESIS, and provide contact information for DEERS, the Managed Care Contractor for Tricare, and the Benefits Counseling Assistance Coordinator as needed.
- Referral Processing: Access MCSC's portal to complete referral reviews, address referral reconciliations, assist patients, MTF or IRMAC staff, or other members of the healthcare team.
- Communication: Collaborate with ordering providers/clinic team to clarify and/or seek information in efforts to process referrals per the guidelines established.
- Training and Development: Participate in in-services, Product Line meetings, staff, and continuing education programs to stay up-to-date on referral management processes and best practices.
- Education: Licensed Registered Nurse, possessing an unencumbered and active RN license from the State Board of Nursing and graduated from an accredited nursing program.
- Experience: Three years of clinical nursing experience is required. RM and Utilization Management (UM) experience is preferred.
- Skills: Proficient in the usage and understanding of medical terminology, MHS, VA-DOD Sharing Program, TRICARE, HIPAA, release of medical information, and computer literacy to interpret and apply medical care criteria.
This is an onsite employment opportunity, however, consideration will be provided for teleworking after the successful completion of 120 days onsite.
