PAC Nurse

Actalent; Lake Worth (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

A forward-thinking company is seeking a dedicated PAC Nurse to join their telephonic care team. This role is pivotal in managing discharge plans and ensuring optimal patient outcomes in post-acute care settings. You will work closely with medical directors and facility personnel to coordinate care, making impactful decisions that enhance patient transitions. This innovative firm offers a fully remote work environment, providing the necessary tools and support for your success. If you are passionate about quality care and have strong clinical expertise, this is an exciting opportunity to make a difference in patients' lives while enjoying a flexible work schedule.

Benefits

Medical, Dental & Vision Insurance

401(k) Retirement Plan

Life Insurance

Short and Long-Term Disability

Health Spending Account

Transportation Benefits

Employee Assistance Program

Paid Time Off (PTO)

Flexible Work Schedule

Remote Work Equipment Provided

Qualifications

• 3+ years of concurrent review and discharge planning experience required.
• Strong clinical knowledge and experience in post-acute care settings.

Responsibilities

• Collaborate with medical directors to ensure proper discharge planning.
• Authorize continued patient stays based on clinical assessments.

Skills

Negotiation Skills

Communication Skills

Problem-Solving Skills

Decision-Making Skills

Clinical Judgment

Critical Thinking

Organizational Skills

Time Management Skills

Education

Associate's Degree in Nursing

LPN or RN License

Tools

Interqual

Milliman/MCG

Job 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, 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.

Responsibilities

1. Collaborate with the PAC Medical Director as needed to ensure proper medical necessity decisions are being rendered.
2. 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.
3. Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives.
4. Receive/respond to requests from unlicensed staff regarding scripted clinical questions and issues.
5. 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.
6. Work alongside the Supervisor, and work closely with Market Engagement Directors to efficiently address potential facility concerns, pushback, or gaps in process.
7. Communicate customer service/provider issues to the supervisor for logging and resolution.
8. Conduct scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay.
9. 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.
10. Use clinical expertise, review clinical information, and clinical criteria to determine if the service/device meets medical necessity for the member.
11. 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.
12. Participate in performance and operational improvement activities.
13. Participate in and contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis, and prepare reports as requested.
14. Assist team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates.
15. Participate in special projects and perform other duties as assigned.
16. Participate in an annual Inter-rater reliability Testing Process.
17. Carry a typical work schedule. Based on business needs, evening and weekend coverage will be needed at times.

Essential Skills

1. Excellent negotiation, influencing, problem-solving, and decision-making skills.
2. Excellent communication (verbal/written), organizational, and interpersonal skills.
3. Ability to work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision.
4. Strong commitment to quality and standards.
5. LPN or RN license.
6. Post-acute nursing experience (i.e., Inpatient Rehab Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility).
7. 3 years of concurrent review experience and/or discharge planning.
8. 2 years of utilization review/management experience.
9. 1 year of experience within Case Management or Transition-of-care role.

Additional Skills & Qualifications

1. Comfortable speaking with providers/offices via phone.
2. Interqual experience.
3. Milliman/MCG experience.
4. Current and unrestricted LPN or RN license.
5. Associate's Degree or Diploma in Nursing/Practical Nursing.
6. Minimum of 2 years of clinical experience in a clinical setting.
7. Experienced in Utilization Management and knowledge of URAC & NCQA standards.
8. Broad knowledge of healthcare delivery/managed care regulations and experience with evidence-based care guidelines (i.e., MCG/Milliman, Interqual).
9. High level of clinical knowledge, communication, customer service, and problem-solving skills, as well as the ability to effectively interact with all levels of management and a highly diverse clientele.
10. Strong organizational skills.
11. Strong time management skills.

Work Environment

Work From Home - Equipment provided. First 3 weeks are training - you must not miss any training days! (If candidate has a scheduling conflict with training, DO NOT SUBMIT). Training schedule: Monday-Friday 8:00am-4:40pm EST. Contract schedule Post Training: Monday-Friday 11am-7:30pm EST (30-minute lunch break). Candidates from PST and MST can be submitted to align better with the schedule.

Pay and Benefits

The pay range for this position is $32.00 - $40.00/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:

1. Medical, dental & vision
2. Critical Illness, Accident, and Hospital
3. 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
4. Life Insurance (Voluntary Life & AD&D for the employee and dependents)
5. Short and long-term disability
6. Health Spending Account (HSA)
7. Transportation benefits
8. Employee Assistance Program
9. 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 Apr 23, 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 & 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:

1. Hiring diverse talent
2. Maintaining an inclusive environment through persistent self-reflection
3. Building a culture of care, engagement, and recognition with clear outcomes
4. 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 [e-mail] for other accommodation options.