PAC Nurse

Actalent; Tampa (FL); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking PAC Utilization Review Nurses for a fully remote role. This position involves collaborating with medical directors and facility personnel to ensure optimal patient care and discharge planning. Successful candidates will leverage their clinical expertise to manage care transitions and address facility concerns while working independently. With a focus on compliance and quality improvement, this role offers an exciting opportunity to make a significant impact in the managed care sector. Enjoy a supportive work environment with provided equipment and flexible scheduling, including evenings and weekends as needed.

Benefits

Health insurance

401(k)

Life insurance

Disability

HSA

Remote work flexibility

Provided equipment

Qualifications

• Current unrestricted LPN or RN license required.
• Minimum 2 years of clinical experience in acute care settings.

Responsibilities

• Collaborate with PAC Medical Director on medical necessity decisions.
• Conduct telephonic reviews to ensure appropriate continued stay.

Skills

Negotiation

Problem-solving

Decision-making

Strong communication

Organizational skills

Interpersonal skills

Utilization management

Case management

Transitional care

Education

Associate's Degree in Nursing

Diploma in Practical Nursing

Tools

Interqual

Milliman/MCG

Job description

Actalent is seeking PAC Utilization Review Nurses for remote work. Qualified candidates should have experience in the managed care/insurance industry. The PAC Nurse role involves recommending discharge plans, assisting with care transitions, and managing the length of stay (LOS) for various post-acute care facilities through collaboration. The position requires working closely with facility personnel, Medical Directors, and other stakeholders to develop timely discharge plans.

Responsibilities include:

1. Collaborating with the PAC Medical Director on medical necessity decisions.
2. Partnering in care planning, reviewing discharge and LOS to ensure optimal outcomes.
3. Providing clinical guidance to unlicensed Post-Acute Care Coordinators.
4. Responding to clinical inquiries from staff.
5. Acting as the primary contact for post-acute facilities for clinical information and patient status updates.
6. Addressing facility concerns and process gaps with supervisors and engagement directors.
7. Communicating with providers to resolve issues.
8. Conducting telephonic reviews to ensure appropriate continued stay.
9. Authorizing continued stays based on medical guidelines and collaboration.
10. Reviewing clinical information to assess medical necessity.
11. Ensuring timely case reviews and determinations.
12. Participating in quality improvement activities and reporting.
13. Supporting compliance with policies, legal, and regulatory standards.
14. Participating in special projects and annual reliability testing.
15. Working a schedule that may include evenings and weekends as needed.

Essential Skills include:

• Negotiation, influencing, problem-solving, and decision-making abilities.
• Strong communication, organizational, and interpersonal skills.
• Ability to work independently with sound clinical judgment.
• Experience in utilization management, case management, and transitional care.
• Experience in acute care settings and medical record management.

Additional Qualifications:

• Current unrestricted LPN or RN license.
• Associate's Degree or Diploma in Nursing/Practical Nursing.
• Minimum 2 years of clinical experience.
• Post-acute nursing and review experience.
• Knowledge of URAC & NCQA standards and evidence-based guidelines.
• Effective interaction with management and diverse clients.
• Strong organizational and time management skills.
• Interqual and Milliman/MCG experience preferred.

Work Environment: Fully remote with provided equipment. Training for 3 weeks, followed by a schedule of Monday-Friday, with some evening and weekend hours as needed.

Pay & Benefits: $32.00 - $40.00/hr, with benefits including health insurance, 401(k), life insurance, disability, HSA, and more, subject to eligibility.

Application Deadline: May 15, 2025.