Care Coordination RN - Discharge & Home Care Advocate

Florida Blue Group; Jacksonville (FL); Hybrid; USD 71,000 - 116,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Paid time off

Holidays

Job summary

Florida Blue is seeking a Clinical Review Nurse Navigator to perform medical reviews ensuring appropriate care levels and to facilitate discharge planning. The role requires nursing licensure in Florida and experience in hospital settings, with travel within Florida likely.

You will partner with providers, care managers and medical directors to coordinate care transitions and identify suitable care programs, benefiting member outcomes and network access.

Qualifications

• 2+ years related work experience; recent clinical experience in hospital, LTAC, Rehab, SNF evaluating benefit determination, medical necessity and appropriate level of care
• Related Bachelor's degree or additional related equivalent work experience Nursing
• Registered Nurse - Florida State Licensure and/or Compact State Licensure including the state of Florida
• Experience in home health care, rehab, SNF, utilization review, discharge planning or case management referrals
• Case Management activities focusing on acute and non-acute services, outpatient services and/or community resources
• Experience with Healthcare industry and Managed Care; MS Word and Excel; moderate to heavy keying
• Occasional travel within the State of Florida

Responsibilities

• Serve as a point of contact for providers to assist in navigating members through the continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and access
• Evaluate members in Hospital, SNF, 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 coordinate ongoing Care Coordination services
• Collaborate with Medical Directors, Managers, Co-workers and other departments including Case Management and Care Partners

Skills

Nursing

Hospital discharge planning

Care coordination

Travel willingness

Education

Bachelor's degree in Nursing

Tools

MS Word

Excel

Job description

Florida Blue is seeking a Clinical Review Nurse Navigator to perform medical reviews ensuring appropriate care levels and to facilitate discharge planning. The role requires nursing licensure in Florida and experience in hospital settings, with travel within Florida likely.

You will partner with providers, care managers and medical directors to coordinate care transitions and identify suitable care programs, benefiting member outcomes and network access.