Registered Nurse (Non-Practicing) – Bethesda, MD

About the role

Ivyhill is seeking a Registered Nurse (Non‑Practicing) to support the Integrated Referral Management and Appointing Center (IRMAC) in Bethesda, MD. The nurse will oversee the review of Right of First Refusal (ROFR) requests, specialty care referrals, and ensure compliance with referral and authorization business rules.

Key responsibilities

• Review referral details for clinical and administrative completeness and determine disposition according to IRMAC guidelines.
• Stay current on facility services, treatment capabilities, and capacity for assigned product lines and specialties.
• Collaborate with Managed Care Support Contract (MCSC), product line leaders, appointing centers, and other healthcare team members to resolve process issues.
• Utilize MHS‑GENESIS, MCSC Portal, and other EHR databases to assess referrals from a market‑based perspective.
• Develop, maintain, and update referral review tools and apply appropriate deferral codes.
• Escalate complex clinical cases to team leads or referral management leadership.
• Communicate referral status to patients and provide guidance for benefit counseling or advocacy.
• Maintain ROFR referrals in MHS‑GENESIS and ensure proper processing to recapture workload from the network.

Required profile

• Active Registered Nurse license (non‑practicing status acceptable).
• Experience reviewing specialty care referrals and understanding of ROFR processes.
• Familiarity with military health system referral workflows and TRICARE benefits.
• Strong analytical skills to assess capacity, capability, and medical necessity.
• Ability to work collaboratively with multidisciplinary teams and maintain professional relationships.

Required skills

• MHS‑GENESIS referral management system
• MCSC Portal
• Electronic Health Record (EHR) systems
• Referral management information systems