PAC Nurse Position Available In Hillsborough, Florida

Job Title:

PAC Nurse Job Description The PAC Nurse position involves telephonic responsibilities focused on recommending discharge plans, assisting with transitions of care, and managing the length of stay for Long Term Acute Hospital, Skilled Nursing Facility, and Institutional Rehab Facility. The role requires collaboration with key facility personnel and medical directors to develop and maintain timely discharge plans. Responsibilities Collaborate with PAC Medical Directors to ensure proper medical necessity decisions are rendered. Partner closely with the PAC Medical Director for care planning, goal setting, and reviewing discharge plans to ensure optimal outcomes. Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing expertise and clarifying referral source directives. Serve as the primary contact for assigned post-acute facilities to obtain clinical information and patient status updates. Work alongside the Supervisor and Market Engagement Directors to address facility concerns and process gaps. Communicate customer service and provider issues to the supervisor for resolution. Conduct scheduled telephonic touchpoints with facility personnel to review member appropriateness for continued stay. Authorize continued stay at SNF, IRF, and Home Health care using approved medical care guidelines. Review clinical information and criteria to determine medical necessity for services/devices. Ensure case reviews and determinations meet contractual and regulatory turnaround time standards. Participate in performance and operational improvement activities. Contribute to ongoing quality assessment and improvement activities, including data collection and report preparation. Assist in implementing standardized operational processes for compliance with company policies and legal requirements. Participate in special projects and carry out other assigned duties. Engage in annual Inter-rater reliability Testing Process. Maintain a typical work schedule with evening and weekend coverage as needed. Essential Skills Excellent negotiation, influencing, problem-solving, and decision-making skills. Strong communication (verbal/written), organizational, and interpersonal skills. Ability to work independently using sound clinical judgment and critical thinking skills. Commitment to quality and standards. LPN or RN with post-acute nursing experience. Minimum 3 years of concurrent review experience and/or discharge planning. At least 2 years of utilization review/management experience. 1 year of experience within Case Management or Transition-of-care role. Additional Skills & Qualifications Comfortable speaking with providers/offices via phone. Experience with Interqual, Milliman/MCG, and managed care. 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. Knowledge of Utilization Management and

URAC & NCQA

standards. Broad knowledge of healthcare delivery, managed care regulations, and evidence-based care guidelines. High level of clinical knowledge and customer service skills. Strong organizational and time management skills. Work Environment This position offers a fully remote work environment with equipment provided. Training is conducted over the first three weeks, Monday to Friday, from 8:00am to 4:40pm EST, and attendance is mandatory. The post-training contract schedule includes longer shifts on Tuesdays and preferred weekend availability. Candidates from PST, MST, and CST time zones can be submitted to better align with the schedule. If interested contact 301 250 4339