Job Title: Post-Acute Clinical Review Nurse (PAC Nurse). This is a Monday to Friday 11am - 8pm EST shift! Can sit anywhere in the US as long as you hold a compact nursing license

Job Description

The Post-Acute Clinical Review Nurse (PAC Nurse) is a telephonic position responsible for recommending discharge plans, assisting with transitions of care, and managing the length of stay (LOS) for Long Term Acute Hospitals (LTACH), Skilled Nursing Facilities (SNF), and Institutional Rehab Facilities (IRF) through collaboration.

Responsibilities

• Collaborate with key facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.
• Work with the PAC Medical Director to ensure proper medical necessity decisions are being made.
• Partner 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 and respond to requests from unlicensed staff regarding scripted clinical questions and issues.
• Serve as the primary contact for assigned post-acute facilities to obtain all clinical information required and proactively obtain patient status updates.
• Work alongside the Supervisor and Market Engagement Directors to address potential facility concerns, pushback, or process gaps.
• Communicate customer service/provider issues to the supervisor for logging and resolution.
• Conduct scheduled telephonic touchpoints with facility point persons 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.
• Use clinical expertise to review clinical information and criteria to determine if services or devices meet medical necessity for the member.
• Ensure case review and elevation to complete determinations within contractual and regulatory turnaround time standards.
• Participate in performance and operational improvement activities.
• Contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improvement analysis and preparing reports as requested.
• Assist the 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.
• Carry a typical work schedule, with potential evening and weekend coverage based on business needs.

Additional Skills & Qualifications

• Current and unrestricted LPN or RN license.
• Associate's Degree or Diploma in Nursing/Practical Nursing.
• Minimum 2 years of clinical experience in a clinical setting.
• Experience in Utilization Management and knowledge of URAC & NCQA standards.
• Broad knowledge of healthcare delivery/managed care regulations and experience with evidence-based care guidelines (e.g., MCG/Milliman, Interqual).
• High-level clinical knowledge, communication, customer service, and problem-solving skills.
• Ability to effectively interact with all levels of management and a highly diverse clientele.
• Strong organizational and time management skills.

Work Environment

This is a fully remote position with equipment provided. The schedule is Monday-Friday from 9am Arizona Time to 6pm Arizona time (10am - 7pm CST or 11am - 8pm EST)

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:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• 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 Feb 27, 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:

• 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 actalentaccommodation@actalentservices.com for other accommodation options.

Salary : $32 - $40