Description
Job Title: PAC Nurse
Job Description
The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care (PAC) facilities through collaboration. The PAC Nurse will collaborate with key facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain a timely discharge plan.
In this role, you will partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes. You will act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. You will also act as the primary contact to the post-acute facility or facilities to which you are assigned to obtain all clinical information required and to proactively obtain patient status updates. Additionally, you will work alongside the Supervisor and Market Engagement Directors to efficiently address potential facility concerns, pushback, or gaps in the process. You will communicate customer service/provider issues to your supervisor and conduct scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay. You will authorize continued stay at SNF, IRF, LTACH, and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel within the healthcare setting. You will use your clinical expertise to review clinical information and criteria to determine if the service/device meets medical necessity for the member and ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards to meet both contractual and regulatory requirements.
Support the following additional duties as requested: Participate in performance and operational improvement activities, contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis and prepare reports as requested, assist the team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates, participate in special projects, and perform other duties as assigned, participate in an annual Inter-rater reliability Testing Process, and carry a typical work schedule. Based on business needs, evening and weekend coverage will be needed at times.
This is the job for you if: you have excellent negotiation, influencing, problem-solving, and decision-making skills. You possess excellent communication (verbal/written), organizational, and interpersonal skills. You can work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision. You hold a strong commitment to quality and standards.
Hard Skills
2 years of concurrent review experience and discharge planning
2 years of utilization review/management experience
Job Type
This is a Contract-to-Hire position with a duration of 12 Month(s).
Work Site
This is a fully remote position.
Work Environment
Work From Home - Equipment provided. First 4 weeks are training- you must not miss any training days!. Training schedule: Monday-Friday 8:00am-4:30pm EST. Contract schedule Post Training: Sunday to Thursday 11am to 8pm EST.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U. S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@ (%20actalentaccommodation@) for other accommodation options.
Compensation Information:
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