Job Description

BTG in partnership with the top ranked Health Insurance company in FL is seeking a Medical Review Nurse. This position includes a competitive compensation and benefits package including Medical, Dental, Vision, and 401k.

Job Duties include but are not limited to the following:
  • Evaluate members in the Acute Hospital, LTAC, Acute Inpatient Rehab and/or Skilled Nursing Facility for benefit determination, medical necessity and appropriate level of care 
  • Participate in weekly case review 
  • Plan, implement, coordinate and monitor care coordination activities that focus on acute and non-acute services, outpatient services and or community resources for
  • Monitor member’s discharge status, identify and coordinate any additional needs or services for successful discharge/transition in care 
  • Collaborate with Medical Directors, Managers, Peers and other departments (e.g. Case Management) 
  • Responsibilities are not all inclusive (e.g., project work may be requested in addition to other responsibilities) 
  • Moderate to heavy keying required.
Job Requirements:
  • Current Florida RN license 
  • 2+ years of 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, esp. Utilization Management 
  • Experience in one or more of the following: Utilization Review, Discharge Planning or Case Management 
  • Experience with the Healthcare industry and Managed Care 
  • Proficient in MS Word, Excel and multiple computer applications
  • Knowledge of NCQA/CMS Standards 
  • InterQual/MCG (Milliman) Care Guidelines 
  • Occasional travel within the State of Florida 
Business Specific Criteria (preferred skills):
  • Bachelor’s degree in related field (i.e. Nursing, Healthcare, Business)
  • Case Management Certification (CCM) 
  • Bilingual
If you believe that your skills and experience are a match for this position, please give us a call at 904-998-9414 to speak to a Recruiter, e-mail your most current resume to apply@btginc.com or apply on line at https://jobs.btginc.com

Application Instructions

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