Concurrent Review Nurse

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $71.2k - $89k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• 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. • Participate in weekly case review • 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 • Other duties as assigned

🎯 Requirements

• 2+ years related work experience. • Experience Details: 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 • Related Bachelor’s degree or additional related equivalent work experience Nursing • 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 Experience in MS Word and Excel Moderate to heavy keying required • Occasional travel within the State of Florida

🏖️ Benefits

• 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