A reputable Healthcare Access Organizaition is currently seeking Referral Management Nurse/Reviewer to assist with a Government client need in the Washington D.C. area. The applicant shall perform the following procedures, as required, and in strict compliance with standing orders and protocols set forth by the MTF to include but will not necessarily be limited to the following:
- Provide Referral Management (RM) activities such as a timely review of Right of First Refusal (ROFR) requests, screening of specialty care referrals, sustaining up- to – date Specialty Clinic Referral and Booking Guidance, comply with Referral and Authorization Business rules, tracking and resulting in referrals, and full use of RM information management systems
- Comply with Referral and Authorization Business rules, tracking and resulting of referrals, and full use of RM information management systems
- Conduct reviews for capacity and capability, and right of first refusal activities
- Reviews referrals for administrative, clinical completeness and appropriateness. Validates requested medical service, and authorizes surgery/medical procedures, laboratory, radiology, pharmacy, and general hospital procedures and regulations.
- Collaborates with DHA Regional Office Clinical Liaison Nurse and MTF Liaison to address any process issues or concerns.
- Project Management
- Microsoft Office
- Maintaining Calendars
- Case Management
- Years of experience: 5 years
- Experience level:Experienced
Working hours: 7:30 AM - 4:30 PM
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