Licensed Practical Nurse Referral Reviewer

Zimmerman Associates, Inc. (ZAI) is currently seeking to hire Licensed Practical Nurse Referral Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions’ premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network.

The candidate must be a U.S Citizenship required as well as ability to obtain a Public Trust Clearance

Pay Rate: $34.57 hrly plus $5.09 H&W

Licensed Practical Nurse Referral Reviewers will be responsible for facilitating centralized product line and specialty referrals for Active-Duty Service Members and Tricare Prime beneficiaries enrolled to a Military Treatment Facility (MTF) in the National Capital Region.

This is an onsite employment opportunity.

• Candidates must possess one of the following combinations of education and experience: (1) an associate’s degree with a minimum of two (2) years of clinical nursing experience, or (2) a high school diploma or equivalent with at least five (5) years of clinical nursing experience. In addition, all candidates must have an active, full, and unrestricted Licensed Practical Nurse (LPN) license from a National League for Nursing–approved program.
• Knowledge, skills, and computer literacy to interpret and apply medical care criteria, such as Inter Qual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs) or other evidence-based guidelines identified by the Military Health System (MHS).
• Knowledge of medical terminology with an ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, release of medical information.
• Effective communication and people skills.
• Superior customer service skills.
• Demonstrated knowledge and understanding of Access to Care Standards within the Direct Care System.
• Attention to detail and the appropriate use of deferral codes.
• Excellent organizational skills, i.e., ability to manage time effectively, prioritize tasks, set goals, and implement plans for achieving those goals.
• Knowledge of Microsoft Suite of Products, including Word, Excel, PowerPoint, Access, Outlook (email), and the Internet is required.

• Perform referral review duties, collaborating with team leads, Product Line Leaders, Appointing Center(s) and other members of the healthcare team and MTF points of contact as necessary. Reviews all referrals for administrative, clinical completeness and appropriateness upon receipt, dispositioning the referral within 24 hours from the date referral was written. Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to address any process issues or concerns, to ensure proper use of Direct Care system and civilian network resources, and to ensure that patients are booked at the right time, with the right provider, at the right place.
• Receives and places telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors and processes referral management Genesis Work Lists to ensure consults are being processed within the established guidelines.
• Advises patients of their referral status. This may include providing references for benefit counseling assistance and/or patient advocacy. Reschedule/instruct patients of other health care options within 3 days of notification of disapproved referral or invalid referral. Advises of Line-of-Duty issues as it relates to referral management.
• Receives and enters ROFR referrals in MHS-GENESIS from the MCSC’s portal for assigned specialties/product lines. Adheres to the defined timelines for response established by MHS, IRMAC standard operating procedures. Identifies and resolves ROFR issues in accordance with NCR Business Rules. Reports concerns related to the ROFR referral process to team lead as needed.
• Completes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines.
• Verifies patients' eligibility in MHS-GENESIS. If a…