Medical Review Nurse RN

GuideWell
Tallahassee, FL
Category Administration
Remote
Job Description
The Medical Review Nurse reviews, authorizes, coordinates, and responds to requests for services for Florida Blue members, including phone/fax referrals and clinical form requests. This role involves determining benefit coverage and referring requests to medical directors for medical necessity determination. It requires on-call work, including holidays and weekends, and must be performed by an RN with state licensure.

Requirements

  • Apply clinical knowledge and expertise to review and authorize requests.
  • Review authorization requests to determine benefit coverage and medical necessity.
  • Provide coverage of provider facing phone queue and answer inbound calls regarding authorizations.
  • Complete benefit and medical necessity reviews using clinical information.
  • Maintain written documentation of communication.
  • Collaborate with other Florida Blue departments.
  • Work rotational weekends, including holidays and over night.

Benefits

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits
  • Leave programs
  • Retirement Savings Plan
  • Paid time off
  • Voluntary benefits
  • Wellness program
  • Employee benefits aligned with federal and state employment laws
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