PAC Nurse

CareCentrix; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated PAC Nurse to manage the length of stay for various post-acute care facilities. In this telephonic role, you will collaborate with healthcare personnel to ensure timely discharge planning and optimal patient outcomes. Your expertise in utilization management and clinical judgment will be crucial in determining medical necessity and addressing facility concerns. This position offers a chance to make a significant impact in patient care while enjoying a supportive work culture with ample benefits, including generous PTO and professional development opportunities. If you are passionate about quality care and looking for a rewarding opportunity, this role is perfect for you.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401K Savings Plan

Paid Parental Leave

Virtual Fitness Training

Tuition Reimbursement

Walgreens Discount

Generous PTO

Annual Corporate Bonus

Qualifications

• Current license as a Licensed Practical Nurse or Registered Nurse required.
• Minimum 2 years clinical experience in a clinical setting.

Responsibilities

• Manage length of stay for post-acute care facilities through collaboration.
• Authorize continued stay using medical care guidelines.

Skills

Utilization Management

Clinical Judgment

Negotiation Skills

Problem-Solving Skills

Organizational Skills

Education

Associate's Degree in Nursing

Diploma in Practical Nursing

Job description

Overview

The PAC Nurse is a telephonic position responsible for managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned post-acute care facilities through collaboration. The PAC Nurse will also collaborate with key facility personnel as well as with CareCentrix internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain a timely discharge plan.

Responsibilities

In this role, you will:

• For assigned 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.
• 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.
• Through the Supervisor, 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.

Support the following additional duties as requested:

• Participate in performance and operational improvement activities.
• Participate in and contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improvement analysis and preparing reports as requested.
• Assist team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates.
• Participate in special projects and perform other duties as assigned.
• Participate in an annual Inter-rater reliability Testing Process.
• Schedule options vary with this role based on business needs; currently, we need nurses willing to work weekend schedules.

Qualifications

You should reach out if:

• You hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse.
• You have an Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent.
• You possess a minimum of 2 years clinical experience in a clinical setting.
• You are an expert in Utilization Management and knowledge of URAC & NCQA standards.
• You have a broad knowledge of health care delivery/managed care regulations and experience with evidence-based care guidelines (i.e., MCG/Milliman, InterQual).
• You have excellent negotiation, influencing, problem-solving, and decision-making skills required.
• You possess organizational skills and are able to effectively manage and prioritize tasks.
• You can work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision.
• You must have a strong commitment to quality and standards.

What we offer:

• Salary Range: $32.00 - $36.00 / hour plus Annual Corporate Bonus incentive.
• Full range of benefits including Health, Dental, and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training, and more.
• Advancement Opportunities, professional skills training, and tuition/exam reimbursement.
• PayActiv - access earned income in between paychecks.
• Walgreens Discount - receive up to 25% off eligible items.
• Great culture with a sense of community.

CareCentrix maintains a drug-free workplace.

#IDCC

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.