Concurrent Review Nurse, Re-Admissions RN

Job not on LinkedIn

🔥 13 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $71.2k - $115.7k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 8%

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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

• Perform medical reviews using established criteria to ensure members receive care at the most appropriate level • Build relationships with facility case managers to facilitate appropriate care and discharge planning • Identify appropriate care programs to support smooth member transitions from facility to home and decrease readmissions • Serve as a provider point of contact for navigating members through the continuum • Educate providers regarding benefits • Identify candidates for Care Programs • Provide information about the network and network access • Evaluate members in hospitals, skilled nursing facilities, LTACs, and acute inpatient rehabilitation for benefit determination, medical necessity, and appropriate level of care • Participate in weekly case reviews • Determine discharge status and coordinate additional needs and services requiring ongoing Care Coordination • Collaborate with Medical Directors, Managers, coworkers, Case Management, and Care Partners • Perform other duties as assigned

🎯 Requirements

• 2+ years related work experience • Recent clinical experience within the past 3–5 years in a hospital, LTAC, rehab, or SNF setting evaluating hospital benefit determination, medical necessity, and appropriate level of care • Related bachelor’s degree or additional related equivalent work experience • 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 making referrals for possible Case Management activities focused on acute and non-acute services, outpatient services, and/or community resources • Healthcare industry and Managed Care experience • Experience with MS Word and Excel • Moderate to heavy keying required • Occasional travel within the State of Florida • Preferred: Bachelor’s degree in Nursing, Healthcare, or Business • Preferred: Unrestricted US RN license

🏖️ Benefits

• Medical, dental, vision, life and global travel health 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 • 2 well-being days • Additional voluntary benefits • Comprehensive wellness program • Opportunities for incentive or commission compensation • Annual reviews with pay-for-performance considerations for base pay increases

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