Registered Nurse; Non-Practicing; Bethesda,MD Job Bethesda area,Maryland USA,Nursing

Registered Nurse (Non-Practicing) (Bethesda, MD)

1 week ago Be among the first 25 applicants

This range is provided by Ivyhill Technologies. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$80,000.00/yr - $95,000.00/yr

Ivyhill is currently seeking to hire a Registered Nurse (Non-Practicing) 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.

Registered Nurse will have overall responsibility for timely review of Right of First Refusal (ROFR) requests, review of Specialty Care Referrals, maintaining up-to-date Referral Review tools and booking guidance, complying with Referral and Authorization Business rules, tracking, and managing referrals using Referral Management (RM) systems. Will conduct reviews for capacity, capability, medical necessity, deferral to network, and ROFR activities.

This is an onsite employment opportunity.

Duties and Responsibilities

Review referral details for suitability, completeness, and required pre-work, adhering to IRMAC guidelines. Collaborate proactively with healthcare team members and stakeholders to resolve process issues.

Utilize MHS-GENESIS, MCSC Portal, and other EHRs to review referrals within established guidelines. Develop and update referral review tools as needed.

Understand and apply deferral processes appropriately, including deferrals for distance, capacity, capability, second opinion, command directives, and continuity of care.

Escalate complex cases or patient concerns to leadership as appropriate.

Manage communication regarding appointments and referrals, monitor queues to ensure timely processing, and advise patients on referral status.

Coordinate approvals for active duty and reserve/guard referrals, collaborating with Medical Director and leadership for non-TRICARE covered referrals.

Maintain ROFR referrals in MHS-GENESIS and related databases to recapture workload from the network.

Establish good interpersonal relationships, analyze and resolve referral-related problems, and manage multiple computer systems for scheduling.

Assist Medicare beneficiaries in coordinating care within the Direct Care System.

Perform additional duties supporting the referral management process and team.

Requirements

Licensed Registered Nurse (RN) with an active, unencumbered license from a State Board of Nursing.
Minimum of three (3) years of clinical nursing experience; RM and UM experience preferred. Full-time nursing employment within the last 24 months is mandatory.
U.S. citizen with knowledge of medical care criteria (e.g., Inter Qual, Milliman, SRGs), medical terminology, and healthcare systems (TRICARE, VA-DOD, HIPAA).
Excellent communication, interpersonal, customer service, leadership, and organizational skills.
Proficient with computers, including Microsoft Office Suite and Windows.

Benefits

Ivyhill offers a competitive benefits package including medical, dental, vision, life and AD&D insurance, short- and long-term disability, supplemental life insurance, and a 401(k) plan.

Additional Details

Seniority level:
Mid-Senior level
Employment type:

Full-time
Job function:
Healthcare Provider
Industries: IT Services and IT Consulting

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Job Posting Language

Registered Nurse; Non-Practicing; Bethesda, MD