Healthcare Navigator
4 weeks ago
Job Summary:
Zimmerman Associates, Inc. (ZAI) is seeking a skilled Healthcare Navigator to support a government contract bid in the Bethesda, MD area. This is an onsite employment opportunity with consideration for teleworking upon customer approval.
Key Responsibilities:
- Timely review of ROFR requests and specialty care referrals
- Review of referrals within established guidelines from a market approach
- Development, maintenance, and update of referral review tools
- Collaboration with IRMAC Booking Protocol Liaison, Product Line Leaders, and other points of contact
- Utilization of deferral codes and understanding of access to care standards
- Verification of patients' eligibility in DEERS and registration in GENESIS
- Accessing MCSC's portal to complete referral reviews and address referral reconciliations
- Review of referrals per month with no more than 5 mistakes
- Elevation of patients' concerns and complex clinical cases to team lead, Product Line leadership, or RM leadership
- Collaboration with Product Line leadership, clinic POCs, and other members of the healthcare team
- Communication with ordering providers and clinic teams
- Orienting and training IRMAC staff on referral management processes and timeliness
- Providing clinical nursing expertise and referral management guidance to patients and staff
- Advising patients of their referral status and providing references for benefit counseling assistance
- Participating in in-services, Product Line meetings, and continuing education programs
- Establishing and maintaining good interpersonal relationships with co-workers and health team members
Requirements:
- Licensed Registered Nurse with an unencumbered and active RN license from the State Board of Nursing
- Three years of clinical nursing experience, with RM and UM experience preferred
- Full-time employment in a nursing field within the last 24 months
- Knowledge of medical care criteria, such as InterQual and Milliman Ambulatory Care Guidelines
- Proficient in medical terminology, MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information
- Excellent oral and written communication skills, interpersonal skills, and customer service skills
- Leadership, organizational, and time management skills
Working Conditions:
This is an onsite employment opportunity with consideration for teleworking upon customer approval.
Equal Opportunity Employer:
ZAI is an equal opportunity employer and welcomes qualified applicants from diverse backgrounds.
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