Clinical Review Nurse RN

2 weeks ago


Jacksonville, Florida, United States Florida Blue Full time

About Us
Florida Blue, a member of the GuideWell family, is dedicated to enhancing the health of individuals and communities. With a legacy of 75 years in providing health insurance, we prioritize quality and affordable health solutions for over five million members across Florida.

Your Role:

The Concurrent Review Nurse (CRN) plays a vital role in conducting medical evaluations based on established guidelines to confirm that members receive care at the most suitable level. This position involves building collaborative relationships with facility case managers to ensure effective care and discharge planning. The CRN is tasked with identifying appropriate care programs for members, facilitating smooth transitions from facilities to home, and minimizing readmission rates.

Key Responsibilities:

  • Act as a liaison for providers, guiding them through the care continuum and educating them about benefits.
  • Assess members in various settings, including hospitals and skilled nursing facilities, to determine benefit eligibility and medical necessity.
  • Engage in weekly case reviews to evaluate member discharge statuses and coordinate ongoing care needs.
  • Collaborate with Medical Directors, Managers, and colleagues across departments to enhance patient care.

Qualifications:
* Minimum of 2 years of relevant experience or a combination of education and experience
* Current RN licensure in Florida or Compact State
* Background in utilization review, discharge planning, or case management
* Familiarity with planning and monitoring case management activities for both acute and non-acute services
* Knowledge of the healthcare industry and managed care principles
* Proficiency in MS Word and Excel
* Willingness to travel occasionally within Florida

Physical Requirements:
This role involves sedentary work, requiring the ability to exert up to 10 pounds of force occasionally.

What We Offer:
At Florida Blue, we foster a culture that emphasizes well-being for both individuals and teams. Our comprehensive benefits package includes:
* Medical, dental, vision, life, and global travel health insurance
* Income protection through life insurance and disability programs
* Leave programs for personal circumstances
* Retirement Savings Plan with employer contributions
* Paid time off, volunteer time off, and 11 holidays
* Additional voluntary benefits and a wellness program

We are committed to providing competitive compensation and conducting regular performance reviews to recognize and reward your contributions.
Florida Blue is an Equal Opportunity Employer, dedicated to fostering a diverse and inclusive workplace.



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