Concurrent Review Nurse RN (REMOTE - PART TIME) id-10202

June 5, 2025

GuideWell is dedicated to advancing health through innovative solutions and partnerships that enhance access to affordable care for individuals and communities.

United States only

Are you a passionate and driven nursing professional looking to make a meaningful impact on the lives of others? Do you thrive in a fast-paced environment where no two days are ever the same? Look no further than Florida Blue, a leading health solutions company dedicated to improving the health and well-being of our members. At Florida Blue, our vision is to be the most trusted and valued health solutions company in the state of Florida, and we believe that our CRNs are essential to achieving this goal. Together, we will transform the healthcare landscape and improve the lives of our members, one care transition at a time!

What Is My Impact?

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The CRN is responsible for performing medical reviews using established criteria to ensure the member is receiving care at the most appropriate level. The CRN builds relationships with facility case managers to facilitate appropriate care and discharge planning. The CRN is responsible for identifying appropriate care programs for members to ensure a smooth transition from facility to home and to decrease frequency of readmission.

Important Information:

This part-time, salaried, REMOTE position that requires a commitment of 16 hours per week, consisting of 8 hours on Saturdays and 8 hours on Sundays. (typically 8am - 5pm EST) We are looking for weekend warriors! The selected candidate must hold an active, unrestricted Florida State Registered Nurse Licensure or Compact Licensure with privileges to practice in Florida. Please note, there may be the occasional travel within the State of Florida for company meetings, trainings, and/or company events.

The Key Responsibilities:

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

What Is Required:

2+ years of clinical experience in a hospital, long term acute care, rehab, or skilled nursing facility setting, evaluating medical necessity and level of care

Experience in Managed Care and one or more of the following: home health care, rehab, skilled nursing facility, utilization review, discharge planning, or case management

Proficient in MS Word and Excel with moderate to heavy keying skills

Related bachelor’s degree or additional related equivalent work experience in nursing

Required Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Florida

What We Prefer:

Knowledge of InterQual

Ability to work in a fast-paced environment both independently as well as in a team setting with multiple deadlines

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

What We Offer:

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

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 as well as a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

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The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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