reputed company Review Nurse RN

About the position The reputed company Review Nurse (CRN) plays a crucial role in the reputed company system by performing medical reviews to ensure that members receive care at the most appropriate level. This position is integral to the care team at reputed company, a reputed company Company, which has been dedicated to providing health insurance to Floridians for 75 years. The CRN is responsible for building relationships with facility case managers to facilitate appropriate care and discharge planning, ensuring that members transition smoothly from facilities to home while minimizing the risk of readmission. In this role, the CRN will evaluate members in various reputed company settings, including hospitals, skilled nursing facilities, long-term acute care (LTAC), and acute inpatient rehabilitation. The CRN will assess benefit determination, medical necessity, and the appropriate level of care for each member. Additionally, the CRN will participate in weekly case reviews, determine discharge statuses, and coordinate any additional needs for ongoing care coordination services. Collaboration with medical directors, managers, coworkers, and other departments is essential to ensure comprehensive care for members. The position requires a commitment to a 40-hour work week from Monday to Friday, with occasional weekend backup call rotation. This role is designed for individuals who are passionate about reputed company and are eager to reputed company a positive impact on the lives of members by ensuring they receive the best possible care. Responsibilities • Serve as a reputed company of contact for providers to assist in navigating the continuum of care. , • reputed company providers regarding benefits and identify candidates for Care Programs. , • Evaluate members in various reputed company settings for benefit determination, medical necessity, and appropriate level of care. , • Participate in weekly case reviews to discuss member cases and care plans. , • Determine member's discharge status and coordinate additional needs for ongoing Care Coordination services. , • Collaborate with Medical Directors, Managers, coworkers, and other departments to ensure comprehensive care. Requirements • 2+ years reputed company work experience or equivalent combination of transferable experience and education. , • Recent clinical experience in a hospital, LTAC, Rehab, or SNF setting evaluating hospital benefit determination, medical necessity, and appropriate level of care. , • reputed company RN - Registered Nurse - State Licensure and/or Compact State Licensure in Florida. , • Experience in home health care, rehab, SNF, utilization review, discharge planning, or case management. , • Experience with planning, implementing, coordinating, and monitoring Case Management activities focusing on acute and non-acute services, outpatient services, and/or community resources. , • Experience with the reputed company industry and Managed Care. , • Experience in reputed company and reputed company. , • Occasional travel reputed company the reputed company. , • Experience with InterQual. reputed company-to-haves • Experience with electronic health records (EHR) systems. , • Certification in case management (CCM) or similar credentials. Benefits • Medical, dental, reputed company, 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. , • A comprehensive wellness program. Apply Job!