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Clinical Review Nurse RN
2 months ago
About Us
Florida Blue, a part of the GuideWell family, is dedicated to enhancing the health of individuals and communities. We are at the forefront of health care transformation, striving to provide accessible and affordable health solutions.
With a legacy of 75 years in health insurance, Florida Blue serves over five million members across the state, embodying our mission to prioritize member health and well-being.
Your Role:
The Concurrent Review Nurse (CRN) plays a crucial role in evaluating medical cases against established criteria to ensure members receive the most suitable level of care. This position involves collaborating with facility case managers to facilitate effective care transitions and discharge planning, while also identifying care programs that support members in their recovery and reduce readmission rates.
Key Responsibilities:
- Act as a liaison for healthcare providers, guiding them through the care continuum and educating them about benefits.
- Assess members in various healthcare settings for benefit eligibility, medical necessity, and appropriate care levels.
- Engage in weekly case reviews to determine discharge statuses and coordinate ongoing care needs.
- Work collaboratively with Medical Directors, Managers, and other departments to ensure comprehensive care.
Qualifications:
* Minimum of 2 years of relevant experience or a combination of education and experience
* Active RN license in Florida or Compact State
* Background in utilization review, discharge planning, or case management
* Familiarity with planning and executing Case Management activities across various service levels
* Knowledge of the healthcare industry and managed care systems
* Proficient in MS Word and Excel
* Willingness to travel occasionally within Florida
Experience with InterQual is preferred.
Physical Requirements:
This role involves sedentary work, requiring occasional exertion of up to 10 pounds to move objects.
What We Provide:
At Florida Blue, we foster a culture that emphasizes well-being and teamwork. 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
* A robust wellness program
We offer competitive compensation, including opportunities for performance-based pay increases.
Florida Blue is an Equal Opportunity Employer committed to diversity and inclusion.
