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.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 Job, you will: Interact 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/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 work closely with Market Engagement Directors to efficiently address potential facility concerns, pushback or gaps in process.Communicate customer service/provider issues to supervisor for logging and resolution.For post-acute facilities:Establish 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, LTACH 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/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 to meet both contractual and regulatory requirements.Support the following additional duties as requested: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 team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.Participate in special projects and performs other duties as assigned.Participate in an annual Inter-rater reliability Testing Process.Carry a typical work schedule. Based on business needs, evening and weekend coverage will be needed at times. Additional Skills & Qualifications:Qualifications:-Current and unrestricted LPN or RN license (TX, GA, FL, KY, NJ, or PA)-Associate'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).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 [email protected] (%[email protected]) for other accommodation options.