Remote Concurrent Review Nurse RN, FL

Florida Blue

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Clinical Full-Time 32990

Get To Know US!
GuideWell and its family of forward-thinking companies are focused on helping people and communities achieve better health and are at the forefront in the transformation of health care.
As a highly integrated care team we empower members to optimize their health and achieve their health care goals by providing access to quality and affordable health solutions.
Florida Blue, a GuideWell Company, has been providing health insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million health care members across the state. We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.

What is your impact?
The Concurrent Review Nurse (CRN) is responsible for performing medical reviews using established criteria to ensure the member is receiving care at the most appropriate level. The CRN builds relationships with facility case managers to facilitate appropriate care and discharge planning. The CRN is responsible for identifying appropriate care programs for members to ensure a smooth transition from facility to home and to decrease frequency of readmission.

What are your responsibilities?
You will serve as a point of contact for providers to assist in navigating them through the continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.  Evaluate members in the Hospital, Skilled Nursing Facility, LTAC, Acute Inpatient Rehab for benefit determination, medical necessity, and appropriate level of care. Participate in weekly case review. Determine member’s discharge status and identify and coordinate any additional needs and service that require ongoing Care Coordination services.  Collaborate with Medical Directors, Managers, Co-worker, and other departments.

What is required?
•    2+ years related work experience or equivalent combination of transferable experience and education–recent (within the past 3-5 years) clinical experience in a hospital, LTAC, Rehab, SNF setting evaluating hospital benefit determination, medical necessity, and appropriate level of care
•    Current RN – Registered Nurse – State Licensure And/Or Compact State Licensure Florida
•    Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case management
•    Experience with planning, implementing, coordinating, and monitoring Case Management activities that focus 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

What is preferred?
Experience with InterQual

General Physical Demands:
Sedentary work:  Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

*** Benefits are based on hours worked***
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
•  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; and
•  A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $66,400 -$107,900
Typical Annualized Hiring Range: $66,400 – $83,000

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.