Medical Review Nurse RN

Florida Blue
Florida, FL
Remote
Job Description
This Medical Review Nurse position involves reviewing, authorizing, and coordinating benefits and medical needs for Florida Blue members. The nurse will document conversations with providers and make decisions based on established policies and guidelines. Rotational on-call and work hours are flexible, requiring both weekend and holiday coverage.

Requirements

  • Apply clinical knowledge and expertise to review and authorize authorization requests.
  • Review authorization requests to determine benefit coverage and medical necessity.
  • Provide coverage of provider facing phone queue.
  • Complete benefit and medical necessity reviews using clinical information.
  • Maintain written documentation of verbal communication.

Benefits

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits
  • Leave programs
  • Retirement Savings Plan
  • Paid time off
  • Volunteer time off
  • Wellness program
  • Incentive or commission compensation
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