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Concurrent Review Nurse RN Remote - Med Surg

Company: Blue Cross Blue Shield of Florida
Location: Jacksonville
Posted on: May 16, 2022

Job Description:

Concurrent Review Nurse RN RemoteWhat will you be doing:

The Concurrent Review Nurse RN (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 will be your purpose:

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 we require:

2 years related work experience or equivalent combination of transferable experience and education

Experience with utilization review using InterQual

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 Florida RN license

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

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.

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

Keywords: Blue Cross Blue Shield of Florida, Jacksonville , Concurrent Review Nurse RN Remote - Med Surg, Healthcare , Jacksonville, Florida

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