Clinical Nurse Specialist
2 weeks ago
Zimmerman Associates, Inc. (ZAI) is seeking a highly skilled Clinical Nurse Specialist to support a government contract bid in the Bethesda, MD area. This is an onsite employment opportunity with consideration for teleworking after the successful completion of 120 days onsite.
Role and Responsibilities:- Review referrals for suitability, administrative and clinical completeness, and required tests and pre-work for disposition per IRMAC guidelines.
- Collaborate with MCSC, Product Line Leaders, RM, Appointing Center(s), and other members of the healthcare team to address process issues or concerns.
- 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.
- Develop, maintain, and update referral review tools.
- Collaborate with IRMAC Booking Protocol Liaison, Product Line Leaders, and other points of contact to ensure booking protocols for assigned product lines are up to date.
- Licensed Registered Nurse with an unencumbered and active RN license from the State Board of Nursing and graduated from an accredited nursing program.
- Three years of clinical nursing experience is required. RM and Utilization Management (UM) experience is preferred.
- Full-time employment in a nursing field within the last 24 months is mandatory.
- Review referrals within the established guidelines from a market approach utilizing MHS-GENESIS Managed Care Support Contract Portal and other EHR's or databases as needed.
- Develops, maintains, and updates as needed, referral review tools.
- Collaborates with IRMAC Booking Protocol Liaison, Product Line Leaders, and other points of contact as needed to ensure booking protocols for assigned product lines are up to date.
- 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-based guidelines identified by the MHS.
- Proficient in the usage and understanding of medical terminology, MHS, VA-DOD Sharing Program, TRICARE, HIPAA, release of medical information.
- Demonstrates ability to manage a high-performing and efficient team.
- Possess excellent oral and written communication skills, interpersonal skills, superior customer service, leadership, and organizational skills.
- Onsite employment opportunity with consideration for teleworking after the successful completion of 120 days onsite.
- Collaborate with MCSC, Product Line Leaders, RM, Appointing Center(s), and other members of the healthcare team to address process issues or concerns.
As an equal opportunity employer, ZAI is committed to providing a work environment that is free from discrimination and harassment. We are an affirmative action employer and provide equal employment opportunities to all qualified applicants 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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