RN Care Coordinator: Discharge & Care Management (Hybrid)

GuideWell; Florida; Hybrid; USD 71,000 - 116,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Paid time off

Job summary

GuideWell in Florida is seeking a Clinical Review Nurse (CRN) to perform medical reviews and coordinate care from hospital to home, ensuring appropriate levels of care and reducing readmissions.

The role involves working with providers, evaluating beneficiaries across settings, and collaborating with Medical Directors and Case Management. Hybrid work with travel within Florida may be required.

Qualifications

• 2+ years related work experience; recent clinical experience in hospital/LTAC/Rehab/SNF evaluating benefit determination and level of care.
• Bachelor’s degree or related equivalent work experience in Nursing.
• Registered Nurse - Florida State Licensure and/or Compact State Licensure including Florida.

Responsibilities

• Serve as a point of contact for providers to assist in navigating members through the continuum and educate regarding benefits.
• Evaluate members in hospital/ SNF settings for benefit determination and medical necessity using InterQual or criteria.
• Participate in weekly case review.
• Determine member discharge status and coordinate ongoing Care Coordination services.

Skills

Registered Nurse (RN) license

Care coordination

Discharge planning

Utilization review

MS Word

Excel

Education

Bachelor’s degree in Nursing

Tools

MS Word

Excel

Job description

GuideWell in Florida is seeking a Clinical Review Nurse (CRN) to perform medical reviews and coordinate care from hospital to home, ensuring appropriate levels of care and reducing readmissions.

The role involves working with providers, evaluating beneficiaries across settings, and collaborating with Medical Directors and Case Management. Hybrid work with travel within Florida may be required.