Registered Nurse - Concurrent Review
About The Position
The Concurrent Review Registered Nurse (CRN) performs medical reviews using established criteria to ensure members receive care at the most appropriate level. The CRN builds relationships with facility case managers to support appropriate care and discharge planning, identifies suitable care programs, and helps members transition from facility to home to reduce readmissions. The role serves as a provider contact for navigating members through the continuum of care, understanding benefits, identifying candidates for care programs, and accessing network information. It evaluates members in hospitals, skilled nursing facilities, LTACs, and acute inpatient rehabilitation settings for benefit determination, medical necessity, and appropriate level of care. The CRN also determines discharge status and coordinates additional needs and services requiring ongoing care coordination. This position offers a hybrid work arrangement combining flexibility with in-office engagement. Team schedules depend on role requirements and business needs, and travel to and from corporate offices may be required. Occasional travel within Florida is also required.
Requirements
- At least 2 years of related work experience.
- Recent clinical experience, within the past 3–5 years, in a hospital, LTAC, rehabilitation, or SNF setting evaluating hospital benefit determination, medical necessity, and appropriate level of care.
- A related bachelor’s degree or additional related equivalent work experience in nursing.
- Registered Nurse licensure in Florida or compact state licensure that includes Florida.
- Experience in one or more of the following: home health care, rehabilitation, SNF, utilization review, discharge planning, or case management.
- Experience with case management activities focused on acute and non-acute services, outpatient services, and/or community resources.
- Healthcare industry and managed care experience.
- Experience using MS Word and Excel.
- Ability to perform moderate to heavy keying.
- Occasional travel within the State of Florida.
- Ability to exert up to 10 pounds of force occasionally to move objects.
Nice To Haves
- Bachelor’s degree in Nursing, Healthcare, or Business.
- Unrestricted US RN license.
- Case Management certification such as ACM or CCM.
Responsibilities
- Serve as a point of contact for providers, helping them navigate members through the continuum of care, understand benefits, identify care program candidates, and obtain 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 using member benefits and InterQual or other medical necessity criteria.
- Participate in weekly case reviews.
- Determine members’ discharge status and identify and coordinate additional needs and services requiring ongoing care coordination.
- Collaborate with Medical Directors, Managers, coworkers, and other departments, including Case Management and Care Partners.
- Identify appropriate care programs and support smooth transitions from facility to home to reduce readmissions.
Benefits
- Medical, dental, vision, life, and global travel health insurance.
- Short- and long-term disability programs and life insurance income protection benefits.
- Leave programs to support personal circumstances.
- Retirement Savings Plan with employer match.
- Paid time off and volunteer time off.
- 10 holidays and 2 well-being days.
- Additional voluntary benefits.
- Comprehensive wellness program.
- Competitive pay and opportunities for incentive or commission compensation.
- Regular annual reviews with pay-for-performance consideration for base pay increases.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
