[Hiring] Concurrent Review Nurse @WebTPA

Role Description

All of our team members and contributors are expected to deliver results with accountability while collaborating seamlessly across boundaries. They embrace change with resilience, staying curious and learning continuously in a rapidly evolving landscape. Grounded in business understanding and comfortable with AI and digital tools, they solve problems with critical thinking and creativity. Above all, they are driven to serve—ensuring their work creates meaningful impact for members and the community we support.

For leadership roles, we seek individuals who think critically, embrace a future-focused mindset, and bring intentional perspective to their work —whether managing people, leading projects, or guiding teams. Our ideal candidates operate across matrix environments, applying systems thinking and evidence-based decision-making to drive sustainable results with economic discipline. We value those who lead change with courage and conviction, building trust across teams, and orchestrating both human and AI capabilities to amplify impact. Across all roles - managing direct reports, leading projects, or advancing individual expertise - they cultivate resources, strengthen capabilities, and create conditions for people and work to thrive. Above all, they are committed to building durable value—decisions and actions today that compound organizational strength tomorrow.

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.

Qualifications

• 2+ years related work experience.
• Recent (within the past 3-5 years) clinical experience in a hospital, LTAC, Rehab, SNF setting evaluating hospital benefit determination, medical necessity and appropriate level of care.
• Related Bachelor’s degree or additional related equivalent work experience in Nursing.
• RN - Registered Nurse - State Licensure And/Or Compact State Licensure Florida.
• Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case management.
• Referrals for possible Case Management activities that focus on acute and non-acute services, outpatient services and/or community resources.
• Experience with the Healthcare industry and Managed Care.
• Experience in MS Word and Excel.
• Moderate to heavy keying required.
• Occasional travel within the State of Florida.

Requirements

• Bachelor’s degree in Nursing, Healthcare or Business (preferred).
• Unrestricted US RN license (preferred).

Benefits

• 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.
• A comprehensive wellness program.

Company Description

As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

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.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.