Remote Concurrent Review Nurse - LPN at Actalent
About the position
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 (PAC) facilities through collaboration. The PAC Nurse will collaborate with key facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain a timely discharge plan. In this role, you will 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. You will act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives. You will also act as the primary contact to the post-acute facility or facilities to which you are assigned to obtain all clinical information required and to proactively obtain patient status updates. Additionally, you will work alongside the Supervisor and Market Engagement Directors to efficiently address potential facility concerns, pushback, or gaps in the process. You will communicate customer service/provider issues to your supervisor and conduct scheduled telephonic touch points with each facility point person to review each member within that facility and confirm appropriateness for continued stay. You will 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. You will use your clinical expertise to review clinical information and criteria to determine if the service/device meets medical necessity for the member and 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, 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, and carry a typical work schedule. Based on business needs, evening and weekend coverage will be needed at times.
Responsibilities
Recommend discharge plans for patients in post-acute care facilities.
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Assist with the transition of care for patients.
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Manage the length of stay (LOS) for LTACH, SNF, and IRF facilities.
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Collaborate with facility personnel and internal Medical Directors to develop discharge plans.
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Partner with the PAC Medical Director in care planning and goal setting.
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Act as a clinical resource for unlicensed Post-Acute Care Coordinators.
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Obtain clinical information and patient status updates from assigned facilities.
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Address facility concerns and gaps in the process with the Supervisor and Market Engagement Directors.
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Conduct scheduled telephonic touch points with facility point persons.
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Authorize continued stay at SNF, IRF, LTACH, and Home Health care as delegated.
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Review clinical information to determine medical necessity for services/devices.
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Participate in performance and operational improvement activities.
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Contribute to ongoing quality assessment/improvement activities.
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Assist in implementing standardized operational processes for compliance.
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Participate in special projects and perform other duties as assigned.
Requirements
2 years of concurrent review experience and discharge planning.
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2 years of utilization review/management experience.
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Excellent negotiation, influencing, problem-solving, and decision-making skills.
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Strong communication (verbal/written), organizational, and interpersonal skills.
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Ability to work independently with sound clinical judgment and critical thinking skills.
Nice-to-haves
Benefits
Fully remote position with equipment provided.
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Training provided for the first 4 weeks.
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Contract-to-Hire position with a duration of 12 months.
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