Licensed Practical Nurse Referral Specialist

21 hours ago

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

Zimmerman Associates, Inc. (ZAI) is seeking a skilled Licensed Practical Nurse Referral Reviewer 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.
  • Proactively monitor and process referral management Genesis Work Lists to ensure consults are processed within guidelines.
Qualifications/Skills and Experience:
  • 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.
  • Working knowledge of computers, specifically the Internet, Microsoft Office, and Windows.
Essential Tasks:
  • Review referrals for appropriateness, administrative and clinical completeness, and Specialty Referral Guideline compliance.
  • Complete the referral review process upon receipt of referral.
  • Regularly review facilities' services, medical treatment capabilities, and capacity for assigned Product Lines/Specialties.
  • Proactively 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.
Requirements:
  • Accurately process referrals per guidelines established from the order date or date consult was directed to queues managed by IRMAC.
  • Accurately enter/process/tracks/closes the ROFR referrals per guidelines established.
  • Receives and enters ROFR referrals in MHS-GENESIS from the MCSC's portal for assigned specialties/product lines.

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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