Hybrid Registered Nurse (Non-Practicing) bei Zimmerman Associates, Inc. (ZAI)

Registered Nurse (Non-Practicing)
Location: Onsite at 6000 MacArthur Blvd, Bethesda, MD 20816
Contract: Integrated Referral Management and Appointing Center (IRMAC) – National Capital Region

About Zimmerman Associates, Inc. (ZAI):
Zimmerman Associates, Inc. (ZAI) is currently seeking several qualified Registered Nurses (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Region’s premier authority for coordinating appointment scheduling and referral management services for beneficiaries within the Defense Health Network. This is an onsite employment opportunity at the Bethesda, MD location.

Role and Responsibilities:

The Registered Nurse (Non-Practicing) is responsible for Referral Management (RM) activities including:

• Timely review of Right of First Refusal (ROFR) requests and specialty care referrals.

• Maintaining and updating Specialty Clinic Referral Review tools and booking guidance.

• Ensuring compliance with Referral and Authorization business rules.

• Tracking and resulting referrals with full use of RM information systems.

• Conducting reviews for capacity, capability, medical necessity, deferral to network, and right of first refusal activities.

Additional responsibilities include: collaborating with healthcare teams, ensuring consults are processed within access-to-care guidelines, managing referral databases, and providing expert clinical guidance to staff and beneficiaries.

Qualifications / Skills and Experience:

• Active Registered Nurse license: Must hold an unencumbered, current, and unrestricted RN license from a State Board of Nursing. License must not be under investigation or subject to adverse action.

• Clinical experience: Minimum of three years in clinical nursing required; Referral Management (RM) and Utilization Management (UM) experience preferred.

• Recent clinical employment: Full-time nursing employment within the past 24 months is mandatory.

• Medical criteria knowledge: Familiarity with InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines, or other evidence-based guidelines used by the Military Health System (MHS).

• Technical proficiency: Knowledge of medical terminology, TRICARE, VA-DOD sharing programs, HIPAA regulations, and release of medical information.

• Communication and leadership: Excellent oral and written communication, interpersonal skills, customer service, organizational and leadership abilities.

• Computer literacy: Proficient with Microsoft Office suite (Word, Excel, PowerPoint, Access) and comfortable navigating complex healthcare information systems.

Essential Tasks Include:

• Review and disposition referrals for clinical completeness and administrative suitability per IRMAC guidelines.

• Collaborate proactively with Managed Care Support Contractors (MCSC), Product Line Leaders, and healthcare teams.

• Ensure timely consult processing aligned with access-to-care standards.

• Manage referral data, produce reports, and maintain review tools.

• Advise patients and clinical staff regarding referral status, eligibility verification, and care coordination.

• Provide training and guidance to referral management staff.

• Assist with special projects and support overall referral management processes.

• Handle up to 1,200–1,600 referrals per month with high accuracy and compliance.

• Occasionally fulfill Call Center Team Lead responsibilities.

Equal Opportunity Employer:

Zimmerman Associates, Inc. (ZAI) is an equal opportunity employer. In accordance with Federal and State Equal Opportunity Laws, qualified applicants are considered for all positions 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.

To Apply:
Please submit your resume and relevant credentials through our careers portal.

#INDSPN