Top 59 Referral specialist Jobs in Springfield, Va

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
Lifeguards needed - NORTHERN VA – Multiple Locations + Flexible Hours & Referral Bonuses
Premier Pool Management —Falls Church, VA
- Up to $22 an hour
- Temporary
- CPR Certification
- Customer service
- First Aid Certification
- Flexible schedule
- Referral program
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
11d
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
Veterinary Assistant (Day Shift) - The Regional Veterinary Referral Center
PetVet Care Centers —Springfield, VA
- $23.40 - $29.70 an hour
- Overtime
- 18 years or older
- Vital signs
- High school diploma or GED
- Paid parental leave
- Health insurance
Quick Apply
Benefits Coordinator
Hillcrest Children Center —Washington, DC
- $25 - $30 an hour
- Mid-level
- 1 year
- Paid holidays
- Health insurance
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
Authorization & Verification Specialist - Acute Team
ContinuumRx —Chantilly, VA
- Full-time
- Microsoft Word
- Microsoft Excel
- HIPAA
Quick Apply
Payor Clearance Specialist
Children's National Hospital —Silver Spring, MD
- $48,672 - $81,120 a year
- Full-time
- Bilingual
- Mid-level
- 3 years
12d
Insurance Verification Representative
Med-Metrix —Arlington, VA
- $20 - $23 an hour
- Full-time
- HIPAA
- High school diploma or GED
- Data entry
12d
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
5d
Part-Time Real Estate Referral Counselor
PenFed Credit Union —Tysons Corner, VA
- $18 - $21 an hour
- Overtime
- Remote
- Mid-level
- Bachelor's degree
- Communication skills
- Paid parental leave
- Disability insurance
Insurance Authorization Specialist
VSI —Reston, VA
- From $23 an hour
- Full-time
- Mid-level
- Office
- Bachelor's degree
- Paid time off
- 401(k) matching
Quick Apply
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
12d
Payor Clearance Associate
Children's National Hospital —Washington, DC
- $43,326.40 - $72,196.80 a year
- Full-time
- Bilingual
- Mid-level
- High school diploma or GED
12d
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
Billing Agent (Contract)
Backpack Healthcare —Washington, DC
- $20 an hour
- Contract
- Remote
- Google Workspace
- Microsoft Excel
- 5 years
Quick Apply

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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

Apply Now

Refine Your Search

referral specialist jobs in springfield, va

Referral Management (Non-Nurse) Reviewer

Licensed Practical Nurse Referral Reviewer

Referral Management (Non-Nurse) Reviewer

Lifeguards needed - NORTHERN VA – Multiple Locations + Flexible Hours & Referral Bonuses

PDN Home Health Authorization Specialist

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

Referral Coordinator-Part Time-DC JAIL

Veterinary Assistant (Day Shift) - The Regional Veterinary Referral Center

Benefits Coordinator

Prior Authorization/Financial Analyst II

Authorization & Verification Specialist - Acute Team

Payor Clearance Specialist

Insurance Verification Representative

Payor Clearance Associate-1

Part-Time Real Estate Referral Counselor

Insurance Authorization Specialist

Payor Clearance Associates

Payor Clearance Associate

Scheduler & Authorization Specialist

Billing Agent (Contract)

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