Part-Time Concurrent Review RN – Every Saturday and Sunday

GuideWell Source

. Perform medical reviews using established criteria to ensure members receive care at the most appropriate level .

Posted 10/2/2026part-timeJacksonville • Florida • United StatesJuniorMid-Level💰 $71,200 - $89,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical necessity evaluation, care coordination, and discharge planning within healthcare settings. Proficient in utilizing clinical criteria and collaborating with multidisciplinary teams to ensure optimal patient care and resource management.

Highest-signal resume keywords

Medical Necessity EvaluationCare CoordinationDischarge PlanningCase ManagementRegistered Nurse License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefit DeterminationClinical EvaluationUtilization ReviewHome Health CareSkilled Nursing Facility ExperienceAcute Inpatient RehabilitationInterQual CriteriaCare Program IdentificationTransition PlanningHealthcare Industry Knowledge

Soft Skills

Relationship BuildingCollaborationCommunicationEducationProblem Solving

Tools & Technologies

MS WordMS Excel

Certifications & Qualifications

Unrestricted US Registered Nurse LicenseFlorida State LicensureCompact State Licensure

Industry Keywords

Managed CareAcute ServicesNon-Acute ServicesOutpatient ServicesCommunity Resources

About the role

Key responsibilities & impact

Perform medical reviews using established criteria to ensure members receive care at the most appropriate level
Build relationships with facility case managers to facilitate appropriate care and discharge planning
Identify appropriate care programs to support smooth transitions from facility to home and decrease readmissions
Serve as a point of contact for providers navigating members through the continuum
Educate providers regarding benefits
Identify candidates for Care Programs
Provide information about the network and network access
Evaluate members in hospitals, skilled nursing facilities, LTACs, and acute inpatient rehabilitation for benefit determination, medical necessity, and appropriate level of care using member benefits and InterQual or other medical necessity criteria
Participate in weekly case review
Determine member discharge status and coordinate additional needs and services requiring ongoing Care Coordination
Collaborate with Medical Directors, managers, coworkers, Case Management, Care Partners, and other departments

Requirements

What you’ll need

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
Unrestricted US Registered Nurse license
Florida State Licensure and/or Compact State Licensure
Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case management
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

Benefits

Comp & perks

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
Comprehensive wellness program
Opportunities for incentive or commission compensation
Regular annual reviews with pay for performance considerations for base pay increases