Clinical - Exception Template

Pacer Group; Georgia; Remote; USD 48,000 - 52,000; Full time

Job summary

Pacer Group is seeking a Quality of Care Coordinator Nurse for a 4-month remote assignment with potential extension and conversion to FTE. The role supports critical incident management, regulatory reporting, and member safety oversight.

The nurse will review referrals, create assessments, liaise with the care coordination team, and help ensure compliance with state and contractual requirements. Requires RN license, Associate's degree, 3+ years of nursing experience; strong MS Word/Excel skills

Qualifications

• RN with clinical nursing background
• Experience in care coordination or incident management preferred
• Proficiency with MS Office (Word/Excel)

Responsibilities

• Check email daily for Critical Incident referrals
• Enter referrals into the Delaware state tool
• Create and complete assessments of assigned member
• Communicate with care coordination team regarding status
• Update tracker of assigned members
• Support appeals case management and medical necessity determinations

Skills

Team player

Communication skills

Willingness to learn

MS Word

Excel

Education

Associate's degree in Nursing

Job description

Job Title: Quality of Care Coordinator Nurse

Duration: 4 Months (Potential Extension and Conversion to FTE)
Location: Remote
Work Schedule: Mon-Fri | 8-5pm EST or 8:30-5:30pm EST

PR: $35-38.00/HR

Summary:

Critical Incident management requires timely review, investigation, reporting, monitoring, provider outreach, corrective action follow-up, and case closure activities, all of which require clinical expertise and judgment.

Timely reporting and ongoing monitoring of Critical Incidents are contractual and regulatory obligations.

This position is necessary to maintain adequate clinical capacity to support compliance requirements, member safety oversight, timely regulatory reporting, and effective management of the Critical Incident and Quality of Care programs. Dedicated RN resources are required to support ongoing reporting, monitoring, investigation, and follow-up activities and ensure sustainable operational performance.

Day to Day Responsibilities:

Quality of Care/Critical Incidents Nurse

• Checking email box daily for Critical Incident referrals
• Entering referrals into the Delaware state tool
• Creating and completing assessments of the assigned member
• Communicating with the care coordination team regarding the status of the assigned member
• Updating tracker of assigned members
• And other tasks based on needs

Appeals and Grievance Nurse

• Coordinating complex appeals case
• Conducting clinical reviews
• Supporting medical necessity determinations
• Collaborating with medical doctors
• Ensuring compliance with state federal and contractual requirements
• Tracking and documenting statuses
• And other tasks based on needs

Education/Certification Required:

• Associate's degree in Nursing

Licensure Required:

• RN any state

Years of experience required:

• 3+ years of experience in nursing or related healthcare experience

Disqualifiers:

• Big gaps in work experience, terminated due to poor performance

Additional qualities to look for:

• high performer

Skills:

• Willingness to learn
• Team player Good communication skills
• Ability to work MS Word and Excel efficiently