Remote PAC Nurse

Actalent is looking for PAC Utilization Review Nurses that will work remote! Qualified candidates must have experience working in the managed care/insurance industry. 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 assigned and non-assigned post-acute care (PAC) facilities through collaboration. The PAC Nurse will work closely with facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.

Collaborate with the PAC Medical Director 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 clarifying referral source directives. Respond to requests from unlicensed staff regarding scripted clinical questions and issues. Serve as the primary contact for assigned post-acute facilities to obtain clinical information and proactively obtain patient status updates. Work alongside the Supervisor and Market Engagement Directors to address potential facility concerns, pushback, or gaps in process. Communicate customer service/provider issues to the supervisor for logging and resolution. Conduct scheduled telephonic touch points with facility point persons to review each member within that facility and confirm appropriateness for continued stay. Authorize continued stay at SNF, IRF, 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 the service/device meets medical necessity for the member. Ensure case review and elevation to complete the determination is rendered within contractual and regulatory turnaround time standards. Participate in performance and operational improvement activities. Contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis and prepare 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 evening and weekend coverage needed at times based on business needs.