Referral Management (Non-Nurse) Reviewer at Zimmerman Associates, Inc

Zimmerman Associates, Inc. (ZAI) is currently seeking to hire several Referral Management (Non-Nurse) 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.

ROLE AND RESPONSIBILITY:

Referral Management (Non-Nurse) 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. However, consideration will be provided for teleworking upon customer's approval.

QUALIFICATIONS/SKILLS AND EXPERIENCES:

• Minimum of an Associate’s degree and a minimum of 2 years’ experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral.
• 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 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.

·