Actalent is hiring Remote PAC Nurses!Job Description
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.
Responsibilities
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.
Essential Skills
Excellent negotiation, influencing, problem-solving, and decision-making skills.
Strong communication (verbal/written), organizational, and interpersonal skills.
Ability to work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision.
Commitment to quality and standards.
Utilization management experience.
Case management experience.
Transitional care experience.
Acute care experience.
Medical record management.
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.
Post-acute nursing experience (e.g., Inpatient Rehab Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility).
3 years of concurrent review experience and/or discharge planning.
2 years of utilization review/management experience.
1 year of experience within Case Management or Transition-of-care role.
Experience in Utilization Management and knowledge of URAC & NCQA standards.
Broad knowledge of health care delivery/managed care regulations and evidence-based care guidelines (e.g., MCG/Milliman, Interqual).
High-level clinical knowledge, customer service, and problem-solving skills.
Ability to effectively interact with all levels of management and a highly diverse clientele.
Strong organizational skills.
Strong time management skills.
Comfortable speaking with providers/offices via phone.
Interqual experience.
Milliman/MCG experience.
Work Environment
Work From Home - Equipment provided. The first 3 weeks are training; candidates must not miss any training days. Training schedule: Monday-Friday 8:00am-4:40pm EST. Schedule post-training: Monday-Friday 11am-7:30pm EST (30-minute lunch break).
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 Apr 28, 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 (%20actalentaccommodation@actalentservices.com) for other accommodation options.
