Concurrent/Post-Acute Review Nurse RN - Remote

Join our team as a Concurrent/ Acute Review Nurse RN, where you'll play a vital role in ensuring our members receive the right care at the right time. As a CRN, you'll build strong relationships with facility case managers, identify opportunities for care transitions, and help reduce hospital readmissions - all while making a meaningful impact on the lives of our members.

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. 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 and participate in weekly case review