Job Title: Registered Nurse (Non-Practicing) - Referral Reviewer Location: Onsite at IRMAC (National Capital Region), with potential for telework upon customer approval Employment Type: Full-Time, Contract Pay Rate: $47.12/hour + $4.93/hour Health and Welfare (HandW) Company: Zimmerman Associates, Inc. (ZAI)

Position Overview:

Zimmerman Associates, Inc. (ZAI) is seeking several Registered Nurses (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC)the lead organization for appointment and referral management for beneficiaries in the Defense Health Network. This is an onsite position with potential for telework upon customer approval.

Key Responsibilities:

Review specialty care referrals for clinical appropriateness, completeness, and deferral decisions.

Apply Access to Care standards, Right of First Refusal (ROFR) rules, and referral business protocols.

Maintain referral tools and collaborate with product line leads and clinical POCs.

Use systems such as MHS GENESIS, DEERS, and MCSC portals to manage and track referrals.

Address patient concerns, eligibility issues, and coordinate follow-ups.

Process 1,200-1,600 referrals per month with high accuracy.

Participate in quality assurance, staff orientation, and process improvement efforts.

Required Qualifications:

Education:

Associates degree in Nursing (required)

Bachelors degree in Nursing (preferred)

Licensure:

Active, unrestricted Registered Nurse (RN) license from a U.S. state

License must remain in good standing during employment

Experience:

Minimum of three (3) years of clinical nursing experience

Employed in a nursing role within the last 24 months

Referral Management or Utilization Management experience preferred

Skills:

Knowledge of InterQual, Milliman, or similar evidence-based guidelines

Familiarity with TRICARE, HIPAA, MHS, VA-DOD sharing protocols

Proficiency in Microsoft Office and electronic health systems (e.g., MHS GENESIS, AHLTA)

Strong communication, critical thinking, and organizational skills

Preferred Skills:

Demonstrated ability to lead or support high-performing teams

Experience in government or military healthcare environments

Familiarity with healthcare navigation for Medicare beneficiaries

ZAI is an equal opportunity employer. In compliance with Federal and State Equal Opportunity Laws, qualified applicants are considered for all positions applied for 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 legally protected status.

Zimmerman Associates, Inc.

Latest Jobs

Registered Nurse (Non-Practicing)