Ivyhill Technologies LLC
Referral Management Reviewers (Bethesda, MD)
Bethesda, Maryland, United States · Contract
Sponsorship not specifiedDetected 650 days ago
ComplianceExcelCustomer SupportHIPAACommunicationOrganizational SkillsMicrosoft OfficeClaims Management
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odds of building a lasting career here
16Unrated
Cap-exempt (no lottery)0
Sponsors this role0
Entry-level history0
PERM / green-card track0
Lottery odds40
Fits your clock70
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About the role
- This is an onsite employment opportunity.
- Reviews all referrals for administrative, clinical completeness and appropriateness, dispositioning the referral within 24 hours from the date referral was written.
- Review Specialty Referral Guideline (SRG) compliance for disposition per IRMAC guidelines.
Responsibilities
- Reports concerns related to the ROFR referral process to team lead as needed.
Requirements
- Completes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines.
Benefits
- Duties and Responsibilities Perform referral review duties, seeking guidance from the product line nurse(s), and other members of the healthcare team and MTF points of contact as necessary.
- This may include providing references for benefit counseling assistance and/or patient advocacy.
- Reschedule/instruct patients of other health care options within 3 days of notification of disapproved referral or invalid referral.
- Submits referrals to non-network providers to TRICARE Service Center for medical necessity/appropriateness review.
Equal opportunity
- Contacts product line nurse/clinic when appropriate for accommodation of highly valuable cases.
Visa & Work Authorization
- Citizen
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This listing is sourced directly from Ivyhill Technologies LLC's careers page and normalized into a canonical job model.