Concurrent Review Nurse RN

About the position The Concurrent Review Nurse (CRN) plays a crucial role in the healthcare system by performing medical reviews to ensure that members receive care at the most appropriate level. This position is integral to the care team at Florida Blue, a GuideWell Company, which has been dedicated to providing health insurance to Floridians for 75 years. The CRN is responsible for building relationships with facility case managers to facilitate appropriate care and discharge planning, ensuring that members transition smoothly from facilities to home while minimizing the risk of readmission. In this role, the CRN will evaluate members in various healthcare settings, including hospitals, skilled nursing facilities, long-term acute care (LTAC), and acute inpatient rehabilitation. The CRN will assess benefit determination, medical necessity, and the appropriate level of care for each member. Additionally, the CRN will participate in weekly case reviews, determine discharge statuses, and coordinate any additional needs for ongoing care coordination services. Collaboration with medical directors, managers, coworkers, and other departments is essential to ensure comprehensive care for members. The position requires a commitment to a 40-hour work week from Monday to Friday, with occasional weekend backup call rotation. This role is designed for individuals who are passionate about healthcare and are eager to make a positive impact on the lives of members by ensuring they receive the best possible care. Responsibilities • Serve as a point of contact for providers to assist in navigating the continuum of care. , • Educate providers regarding benefits and identify candidates for Care Programs. , • Evaluate members in various healthcare settings for benefit determination, medical necessity, and appropriate level of care. , • Participate in weekly case reviews to discuss member cases and care plans. , • Determine member's discharge status and coordinate additional needs for ongoing Care Coordination services. , • Collaborate with Medical Directors, Managers, coworkers, and other departments to ensure comprehensive care. Requirements • 2+ years related work experience or equivalent combination of transferable experience and education. , • Recent clinical experience in a hospital, LTAC, Rehab, or SNF setting evaluating hospital benefit determination, medical necessity, and appropriate level of care. , • Current RN - Registered Nurse - State Licensure and/or Compact State Licensure in Florida. , • Experience in home health care, rehab, SNF, utilization review, discharge planning, or case management. , • Experience with planning, implementing, coordinating, and monitoring Case Management activities focusing on acute and non-acute services, outpatient services, and/or community resources. , • Experience with the Healthcare industry and Managed Care. , • Experience in MS Word and Excel. , • Occasional travel within the State of Florida. , • Experience with InterQual. Nice-to-haves • Experience with electronic health records (EHR) systems. , • Certification in case management (CCM) or similar credentials. Benefits • Medical, dental, vision, life and global travel health insurance. , • Income protection benefits: life insurance, short- and long-term disability programs. , • Leave programs to support personal circumstances. , • Retirement Savings Plan includes employer contribution and employer match. , • Paid time off, volunteer time off, and 11 holidays. , • Additional voluntary benefits available. , • A comprehensive wellness program. Apply Job!