LPN Referral Reviewer

4 weeks ago


Bethesda, Maryland, United States Ivyhill Technologies Full time
Job Title: LPN Referral Reviewer

Ivyhill Technologies is seeking a highly skilled LPN Referral Reviewer to join our team. As an LPN Referral Reviewer, you will be responsible for reviewing referrals for appropriateness, administrative and clinical completeness, and Specialty Referral Guideline (SRG) compliance.

Key Responsibilities:
  1. Review referrals for appropriateness, administrative and clinical completeness, and SRG compliance.
  2. Complete the referral review process upon receipt of referral.
  3. Review facilities' services, medical treatment capabilities, and capacity for Product Lines/Specialties assigned.
  4. Collaborate with Team Leads, Product Line Leaders, Appointing Center(s), and other members of the healthcare team to address process issues or concerns.
  5. Ensure consult processing is done within established Access to Care guidelines.
  6. Process referrals per the guidelines established from the order date or date consult was directed to queues managed by customer.
  7. Close unused referrals as directed by DHA IPM, NCR MD policies, and notify ordering provider accordingly.
Requirements:
  1. LPNs must have a current, active, full, and unrestricted License to practice nursing in accordance with State, and 2 years of clinical nursing experience is required.
  2. 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-base guidelines identified by the MHS.
  3. Possess excellent oral and written communication skills, interpersonal skills, superior customer service, and organizational skills.
  4. Have working knowledge of computers, specifically the Internet, Microsoft Word, Excel, PowerPoint, Access, and Windows.

About Ivyhill Technologies: Ivyhill Technologies is an equal opportunity employer. We are committed to providing a work environment that is free from discrimination and harassment. We are proud to offer a competitive benefits program, including medical, dental, and vision; Life and AD&D insurance; Short- and Long-Term Disability; supplemental Life insurance, and a 401(k) Plan.



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