Referral Management Reviewers (Bethesda, MD)

divh2Referral Management (Non-Nurse) Reviewers/h2pTeam Ivyhill is currently seeking to hire Referral Management (Non-Nurse) Reviewers to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions premier coordinating authority for appointing and referral management services for beneficiaries in the Defense Health Network./ppReferral Management (Non-Nurse) Reviewers will be responsible for facilitating centralized product line and specialty referrals for Active-Duty Service Members and Tricare Prime beneficiaries enrolled to a Military Treatment Facility (MTF) in the National Capital Region./ppThis is an onsite employment opportunity./ppDuties and Responsibilities/polliPerform 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. Reviews all referrals for administrative, clinical completeness and appropriateness, dispositioning the referral within 24 hours from the date referral was written. Collaborates with appointing center, case managers, product line nurses, providers, clinics, manage care support contractor liaison and other members of the healthcare team as needed to ensure proper use of Direct Care system and civilian network resources, as well as to ensure that patients are booked at the right time, with the right provider, at the right place./liliReview Specialty Referral Guideline (SRG) compliance for disposition per IRMAC guidelines./liliCompletes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines./liliReceives and places telephone calls and computer/written correspondence regarding specialty clinic appointments and referrals. Routinely monitors and processes referral management Genesis Work Lists to ensure consults are being processed within the established guidelines./liliAdvises patients of their referral status. 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. Advises of Line-of-Duty issues as it relates to referral management./liliReceives and enters ROFR referrals in MHS-GENESIS from the MCSCs portal for assigned specialties/product lines. Adheres to the defined timelines for response established by MHS, IRMAC standard operating procedures. Identifies and resolves ROFR issues in accordance with NCR Business Rules. Reports concerns related to the ROFR referral process to team lead as needed./liliCompletes and returns Clear Legible Reports (CLR) to the ordering civilian provider within the required ROFR timelines./liliVerifies patients eligibility in MHS-GENESIS. Update demographic information when needed./liliDocument in MHS-GENESIS, explaining appropriate options to patients when they refuse appointments within access to care (i.e., point of service, Tricare Select, be connected to Beneficiary Counselor and Assistance Coordinator)./liliContacts product line nurse/clinic when appropriate for accommodation of highly valuable cases./liliInterfaces with the MCSC and multidisciplinary personnel as needed to ensure appropriateness of referrals. Submits referrals to non-network providers to TRICARE Service Center for medical necessity/appropriateness review./liliRoutinely monitors referral management voicemail to ensure patient calls are returned within the guidelines established./liliProvides information about EPRO to requestors outside the NCR requesting care within the NCR./liliCloses unused referrals as directed by DHA IPM, NCR MD policies and notifies ordering provider accordingly./liliOrients and trains new IRMAC staff in the referral processes and timelines./liliOther duties as assigned./li/ol/div