Healthcare Navigator

4 weeks ago


Bethesda, Maryland, United States Zimmerman Associates Full time

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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