United States onlyJoin our team as a Concurrent/ Acute Review Nurse RN, where you'll play a vital role in ensuring our members receive the right care at the right time. As a CRN, you'll build strong relationships with facility case managers, identify opportunities for care transitions, and help reduce hospital readmissions - all while making a meaningful impact on the lives of our members.
What are the Key Accountabilities:
- Serve as a point of contact for providers to assist in navigating members 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 utilizing member benefits and InterQual or other medical necessity criteria.
- Determine member's discharge status and identify and coordinate any additional needs and services that require ongoing Care Coordination services
- Collaborate with Medical Directors, Managers, Co-workers and other departments including Case Management and Care Partners and participate in weekly case review
What is Required:
- 2+ years’ recent experience (within the past 3-5 years) clinical experience in a hospital, LTAC, Rehab, Skilled Nursing Facility setting evaluating hospital benefit determination, medical necessity and appropriate level of care
- 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 Referrals for possible 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
- Related Bachelor’s degree or additional related equivalent work experience Nursing
What is Preferred:
- Experience in post-acute care admission
- Bachelor’s degree Nursing, Healthcare or Business
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.
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 including employer match,
- Paid time off, volunteer time off, 10 holidays and 2 well-being days,
- 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.
Typical Annualized Hiring Range: $69,400 - $86,800, within a full annualized salary range of $69,400 - $112,800
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 Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
