Top 1800 Call Reviewer Jobs

Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $23.56 an hour
- Microsoft Excel
- Microsoft Outlook
- Mid-level
Student Safety Specialist (Content Reviewer) — Part-Time / On-Call
Lightspeed Systems —Remote
- Part-time
- Writing skills
- Physical & Rehabilitation Medicine
- High school diploma or GED
10d
Group Life Claim Reviewer
MetLife —Remote
- $41,600 - $54,000 a year
- Email
- Remote
- Microsoft Word
- Microsoft Excel
- Windows
- Paid training
- Paid holidays
Payments Case Reviewer Specialist
ATC —Fargo, ND
- Contract
- Mid-level
Customer Support Specialists, AI Response Evaluation
mpathic —Seattle, WA
- $30 - $40 an hour
- Part-time
- Remote
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
14d
On-Call Senior Federal Rulemaking Specialist (REMOTE ROLE)
ICF —Reston, VA
- $67,355 - $114,503 a year
- Part-time
- Remote
- Microsoft Outlook
- Master's degree
- Analysis skills
SNAP Integrity Reviewer
State of Illinois —Bloomington, IL
- $5,834 - $8,307 a month
- Full-time
- Bilingual
- Mid-level
- Office
- Paid parental leave
- Paid holidays
7d
ECM Enrollment Representative - Remote
Medzed LLC —San Antonio, TX
- $20 an hour
- Full-time
- Remote
- Spanish
- HIPAA
- English
Quick Apply
Second Level Reviewer I
AdventHealth Corporate —Altamonte Springs, FL
- $66,170.74 - $123,073.07 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Disability insurance
Bill Reviewer III
AvonRisk —Rocklin, CA
- $25 - $30 an hour
- Full-time
- Hybrid work
- Word processing
- Computer literacy
- Basic math
- Health savings account
- Paid holidays
Quick Apply
Medical Front Office Coordinator (AI Model Training)
FIND Healthcareers —Dallas, TX
- Temporary
- Remote
- Spanish
- English
- Mid-level
Quick Apply
Coordinator, UM Intake
Evolent Health —Remote
- $18 - $20 an hour
- Full-time
- Background check
- Computer literacy
- Pass drug screening
- Health insurance
Client Coordinator
MES Solutions —Atlanta, GA
- $17 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
6d
Core Ops Data Integrity Reviewer (QC)
Capital One —Richmond, VA
- Email
- Microsoft Outlook
- Military
- Mid-level
- Health insurance
- Work from home
HVAC Scheduling Coordinator
Johnson Controls —Jacksonville, FL
- $21.92 - $30.16 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Team management
- Paid holidays
- Health insurance
Clinical Services Manager
Havenwyck Hospital (UHS) —Auburn Hills, MI
- From $70,000 a year
- Full-time
- Master of Social Work
- Psychiatry
- Mid-level
- Loan repayment program
- Health insurance
Quick Apply
11d
FT Director of Utilization Review
River Point Behavioral —Jacksonville, FL
- Full-time
- Background check
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Quick Apply
ENT Physician Reviewer | NC License
BHM Healthcare Solutions —Remote
- Part-time
- Remote
- 5 years
- BC/BE
- Senior level
- Flexible schedule
Quick Apply
Environmental Senior Project Manager
Pinchin LLC —Portsmouth, NH
- Hybrid work
- Microsoft Excel
- Bachelor of Science
- Ability to lift 50 pounds
- Paid parental leave
- Paid holidays
Quick Apply
Fleet Coordinator
Vista Trans —Huntley, IL
- $78,000 - $83,200 a year
- Full-time
- Background check
- CDL A
- Mid-level
Quick Apply

I want to receive the latest job alert for Call Reviewer

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Call Reviewer jobs near

Referral Management (Non-Nurse) Reviewer

Zimmerman Associates, Inc. -
Bethesda, MD

Apply Now

Job Details

$23.56 an hour

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Associate's degree
Medical terminology

Full Job Description

Zimmerman Associates, Inc. (ZAI) is seeking to hire multiple Referral Management (Non-Nurse) Reviewers to support our contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region’s premier authority for appointment coordination and referral management services for beneficiaries within the Defense Health Network.

Pay Rate: $23.56 per hour plus $4.93 Health & Wellness Fringe

Role and Responsibilities:

Referral Management (Non-Nurse) Reviewers will facilitate centralized product line and specialty referrals for Active-Duty Service Members and TRICARE Prime beneficiaries enrolled at Military Treatment Facilities (MTFs) within the National Capital Region.

This is an onsite opportunity

Qualifications / Skills / Experience:

Minimum of an Associate’s degree
At least 2 years of experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral
U.S. Citizenship required, with the ability to obtain a Public Trust Clearance
Knowledge of medical care criteria such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs), or other evidence-based Military Health System (MHS) guidelines
Familiarity with medical terminology and ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information protocols
Excellent communication and interpersonal skills
Strong customer service orientation
Understanding of Access to Care Standards within the Direct Care System
Attention to detail, including correct use of deferral codes
Strong organizational skills with ability to prioritize tasks and manage time effectively
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Access, Outlook) and internet navigation

Essential Tasks:

Review and process referrals for administrative and clinical completeness and appropriateness, completing disposition within 24 hours of referral date
Collaborate with appointing centers, case managers, product line nurses, providers, clinics, managed care contractors, and other healthcare team members to ensure appropriate use of Direct Care and civilian network resources
Ensure patients are scheduled with the right provider, at the right time and place
Review compliance with Specialty Referral Guidelines (SRGs) per IRMAC protocols
Complete and return Clear Legible Reports (CLR) to ordering civilian providers within required Return of Favorable Response (ROFR) timelines
Manage telephone, written, and electronic communications regarding specialty appointments and referrals
Monitor and process referral management worklists (e.g., Genesis Work Lists) to ensure timely consult processing
Communicate referral status to patients, including benefit counseling and advocacy resources as needed
Reschedule or redirect patients within 3 days when referrals are disapproved or invalid, advising on other care options and Line-of-Duty issues
Receive and enter ROFR referrals in MHS-GENESIS from Military Contractor Support Centers (MCSC) portals for assigned specialties/product lines, adhering to all timelines and business rules
Verify patient eligibility and update demographics in MHS-GENESIS
Document patient interactions, especially when appointments are refused, and coordinate with Beneficiary Counselor and Assistance Coordinator as appropriate
Coordinate with product line nurses and clinics for special accommodations
Interface with MCSC and multidisciplinary teams to ensure referral appropriateness
Submit referrals to non-network providers for TRICARE Service Center medical necessity reviews
Monitor referral management voicemail and return patient calls within established guidelines
Provide External Provider Referral Online (EPRO) information as requested
Close unused referrals following DHA IPM and NCR Medical Directorate policies, notifying ordering providers accordingly
Orient and train new IRMAC staff on referral processes and timelines
Perform other duties as assigned

Zimmerman Associates, Inc. is an equal opportunity employer. We comply with Federal and State Equal Opportunity laws and consider 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 protected status.

#INDSPN

Apply Now

Refine Your Search

Call Reviewer jobs

Referral Management (Non-Nurse) Reviewer

Student Safety Specialist (Content Reviewer) — Part-Time / On-Call

Group Life Claim Reviewer

Payments Case Reviewer Specialist

Customer Support Specialists, AI Response Evaluation

On-Call Senior Federal Rulemaking Specialist (REMOTE ROLE)

SNAP Integrity Reviewer

ECM Enrollment Representative - Remote

Second Level Reviewer I

Bill Reviewer III

Medical Front Office Coordinator (AI Model Training)

Coordinator, UM Intake

Client Coordinator

Core Ops Data Integrity Reviewer (QC)

HVAC Scheduling Coordinator

Clinical Services Manager

FT Director of Utilization Review

ENT Physician Reviewer | NC License

Environmental Senior Project Manager

Fleet Coordinator

I want to receive the latest job alert for Call Reviewer

Related Searches

Explore jobs in more locations

Role and Responsibilities:

Qualifications / Skills / Experience:

Essential Tasks:

Job Seeker Tools

Employer Tools

Browse

Stay Connected