Top 72 Referral specialist Jobs in Silver Spring, Md

Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $23.56 an hour
- Microsoft Excel
- Microsoft Outlook
- Customer service
Licensed Practical Nurse Referral Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $34.57 an hour
- Nursing
- Microsoft Excel
- Microsoft Outlook
Referral Management (Non-Nurse) Reviewer
Zimmerman Associates, Inc. —Bethesda, MD
- $24.13 an hour
- Microsoft Excel
- Microsoft Outlook
- Customer service
Information & Referral Specialist (Part-Time & Full-Time)
Community Crisis Services —Hyattsville, MD
- $21.05 an hour
- 12 hour shift
- Hybrid work
- Computer literacy
- English
- High school diploma or GED
- Paid holidays
- Disability insurance
Referral Coordinator-Part Time-DC JAIL
Unity Health Care. —Washington, DC
- $49,770 - $55,300 a year
- Part-time
- Spanish
- English
- Mid-level
Quick Apply
Benefits Coordinator
Hillcrest Children Center —Washington, DC
- $25 - $30 an hour
- Mid-level
- 1 year
- Paid holidays
- Health insurance
Quick Apply
10d
Payor Clearance Associate-1
Children's National Hospital —Silver Spring, MD
- $43,326.40 - $72,196.80 a year
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
4d
Payor Clearance Associates
Children's National Hospital —Silver Spring, MD
- $43,326.40 - $72,196.80 a year
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
11d
Payor Clearance Specialist
Children's National Hospital —Silver Spring, MD
- $48,672 - $81,120 a year
- Full-time
- Bilingual
- Mid-level
- 3 years
- Commuter assistance
- AD&D insurance
Payor Clearance Associate
Children's National Hospital —Silver Spring, MD
- $43,326.40 - $72,196.80 a year
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
- Commuter assistance
- AD&D insurance
Benefits & Auth for Physical Therapy
RSI-Rehabilitation Services, Inc. —Laurel, MD
- $23 - $29 an hour
- Full-time
- Medical office experience
- HIPAA
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
PDN Home Health Authorization Specialist
COMFORT HOME HEALTH LLC —Falls Church, VA
- $25 - $30 an hour
- Full-time
- Hybrid work
- Spanish
- HIPAA
- English
- Health insurance
- 401(k)
Quick Apply
10d
Prior Authorization/Financial Analyst II
MedStar Health —Washington, DC
- $59,820 - $101,836 a year
- Full-time
- Hospital
- Mid-level
- 3 years
5d
Scheduler & Authorization Specialist
The Centers for Advanced Orthopaedics LL —Chevy Chase, MD
- $21 an hour
- English
- Mid-level
- High school diploma or GED
Quick Apply
Insurance Authorization Specialist/ Medical Assistant
Lifeline Vascular Care —Colmar Manor, MD
- $23 - $30 an hour
- Online Application
- Background check
- Mid-level
- Clinic
- Health savings account
- Paid holidays
Quick Apply
Care Coordination Manager - Veterinary Referral Associates
PetVet Care Centers —Gaithersburg, MD
- $30 - $35 an hour
- 8 hour shift
- Hospitality
- 18 years or older
- Basic math
- Paid parental leave
- Health insurance
Quick Apply
Internal Medicine Veterinary Receptionist (Care Coordinator) - Veterinary Referral Associates
PetVet Care Centers —Gaithersburg, MD
- $20 - $27 an hour
- 8 hour shift
- 18 years or older
- High school diploma or GED
- Medical terminology
- Paid parental leave
- Health insurance
Quick Apply
11d
Patients Benefits Representative (Largo)
Maryland Oncology —Largo, MD
- $19.82 - $30.40 an hour
- Microsoft Excel
- HIPAA
- 3 years
Physical Therapy Insurance Specialist / Patient Care Coordinator
Synergy Physical Therapy —Fulton, MD
- $20 - $30 an hour
- Part-time
- In-person
- Outpatient
- Entry level
Quick Apply
17h
Dental Insurance Coordinator/ Front Desk
Homey Dental Group —Gaithersburg, MD
- $24 - $29 an hour
- Part-time
- Background check
- Dental office
- Mid-level
- Dental insurance
Quick Apply
12d

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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
Customer service
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

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Refine Your Search

referral specialist jobs in silver spring, md

Referral Management (Non-Nurse) Reviewer

Licensed Practical Nurse Referral Reviewer

Referral Management (Non-Nurse) Reviewer

Information & Referral Specialist (Part-Time & Full-Time)

Referral Coordinator-Part Time-DC JAIL

Benefits Coordinator

Payor Clearance Associate-1

Payor Clearance Associates

Payor Clearance Specialist

Payor Clearance Associate

Benefits & Auth for Physical Therapy

PDN Home Health Authorization Specialist

Prior Authorization/Financial Analyst II

Scheduler & Authorization Specialist

Insurance Authorization Specialist/ Medical Assistant

Care Coordination Manager - Veterinary Referral Associates

Internal Medicine Veterinary Receptionist (Care Coordinator) - Veterinary Referral Associates

Patients Benefits Representative (Largo)

Physical Therapy Insurance Specialist / Patient Care Coordinator

Dental Insurance Coordinator/ Front Desk

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