The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with the transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital, Skilled Nursing Facility, and Institutional Rehab Facility 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.
ResponsibilitiesCollaborate with the PAC Medical Director as needed to ensure proper medical necessity decisions are being rendered.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.Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives.Receive and respond to requests from unlicensed staff regarding scripted clinical questions and issues.Act as the primary contact to the post-acute facility or facilities to which they are assigned to obtain all clinical information required and to proactively obtain patient status updates.Work alongside the Supervisor and closely with Market Engagement Directors to efficiently address potential facility concerns, pushback or gaps in the process.Communicate customer service or provider issues to the supervisor for logging and resolution.Conduct scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay.Authorize continued stay at SNF, IRF, and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel within the healthcare setting.Use clinical expertise, review clinical information and clinical criteria to determine if the service or device meets medical necessity for the member.Ensure case review and elevation to complete the determination is rendered within the contractual and regulatory turnaround time standards.Essential SkillsCurrent and unrestricted LPN or RN license.Post-acute nursing experience (i.e. Inpatient Rehab Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility).3 years of concurrent review experience and/or discharge planning.2 years of utilization review/management experience.1 year of experience within Case Management or Transition-of-care role.Strong commitment to quality and standards.Additional Skills & QualificationsAssociate's Degree or Diploma in Nursing/Practical Nursing.MINIMUM 2 years clinical experience in a clinical setting.Experienced in Utilization Management and knowledge of URAC & NCQA standards.Broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, Interqual).High level clinical knowledge, communication, customer service and problem solving skills.Strong organizational skills.Strong time management skills.Comfortable speaking with providers/offices via phone.Interqual experience.Milliman/MCG experience.Work Environment
Work From Home - Equipment provided. The 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: Monday-Friday 11am-7:30pm EST (30 minute lunch break). Candidates from PST and MST can align better with the schedule. Fully-remote work with the opportunity to go permanent with a large managed care organization. After completing the initial 90-day probationary period, candidates are eligible for up to 40 hours of PTO and 6 paid holidays. Evening and weekend coverage may be needed based on business needs.
Pay and BenefitsThe pay range for this position is $32.00 - $39.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Feb 26, 2025.
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.
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