Job Description
The PAC Nurse/LPN is a telephonic position responsible for recommending discharge plans, assisting with the transition of care, and managing the length of stay for Long Term Acute Hospital, Skilled Nursing Facility, and Institutional Rehab Facility for their assigned and non-assigned post-acute care facilities through collaboration.
ResponsibilitiesCollaborate with key facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.Work with the PAC Medical Director 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.Receive and respond to requests from unlicensed staff regarding scripted clinical questions and issues.Act as the primary contact for 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 process.Communicate customer service and provider issues to the supervisor for logging and resolution.Conduct scheduled telephonic touchpoints with each facility point person to review each member within that facility and confirm appropriateness for continued stay.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.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.Participate in performance and operational improvement activities.Participate in and 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.Carry a typical work schedule, with evening and weekend coverage needed at times based on business needs.Essential SkillsCurrent and unrestricted LPN or RN licenseAssociate's Degree or Diploma in Nursing/Practical NursingMinimum 2 years of clinical experience in a clinical settingExperience in Utilization Management and knowledge of URAC & NCQA standardsBroad knowledge of healthcare delivery/managed care regulations and experience with evidence-based care guidelines (i.e. MCG/Milliman, Interqual)High level of clinical knowledge, communication, customer service, and problem-solving skillsAbility to effectively interact with all levels of management and a highly diverse clienteleStrong organizational skillsStrong time management skillsAdditional Skills & QualificationsComfortable speaking with providers and offices via phoneInterqual experienceMilliman/MCG experienceManaged care experienceUtilization review experienceConcurrent review experienceDischarge planning experienceHospital experienceWork Environment
This is a fully-remote position with equipment provided. The first 4 weeks consist of training, which is mandatory and scheduled Monday-Friday 8:00am-4:30pm EST. After training, the schedule is Monday-Friday 11:00am-7:30pm EST with a 30-minute lunch break. Candidates from PST and MST time zones are encouraged to apply to align better with the schedule. Candidates are eligible for up to 40 hours of PTO (1 week or 5 days) and 6 paid holidays after completing an initial 90-day probationary period. There is also an opportunity to go permanent with a large managed care organization.
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.
Diversity, Equity & InclusionAt 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 peopleThe 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@actalentservices.com for other accommodation options.