CareCentrix PAC Nurse in Remote, United States
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 (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned and non-assigned post-acute care facilities through collaboration PAC Nurse will also collaborate with key facility personnel as well as with CareCentrix internal Medical Directors, Market Engagement Directors and Nurse Mangers to develop and maintain a timely discharge plan.
In this Job, you will:
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.
Work alongside the Supervisor, and 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.
For 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.
Support the following additional duties as requested:
Participate in performance and operational improvement activities.
Participate in and contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis and prepare reports as requested.
Assist team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
Participate in special projects and performs other duties as assigned.
Participate in an annual Inter-rater reliability Testing Process.
Carry a typical work schedule is Monday thru Friday 8am to 6pm. Based on business needs, evening and weekend coverage may be needed at times.
This is the job for you if:
You have excellent negotiation, influencing, problem solving and decision making skills required.
You possess excellent communication (verbal/written), organizational and interpersonal skills.
You can work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision.
You hold a strong commitment to quality and standards.
You should get in touch if:
You hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse.
You Have obtained an Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent
You Have a minimum of 2 years clinical experience in a clinical setting
You can bring expertise 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 a high level 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.
You have strong organizational skills and will be able to effectively manage and prioritize tasks.
CareCentrix maintains a drug-free workplace.
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.
External Company URL: www.carecentrix.com