CareCentrix

PAC Nurse

CareCentrix

United States
Aug 6th, 2022
CareCentrix is committed to making the home the center of patient care.

We have more than 20 years of experience working with payors and providers to create programs that improve quality and lower costs by allowing patients to heal or age where they want to be: at home. We currently manage care for 26 million members through over 8,000 provider locations.

Through advanced analytics, we determine the appropriate site for post-acute care, and provide support and coordination for patients and their families throughout care transitions, including to and from Skilled Nursing Facilities (SNFs) and through Home Health, Home DME, Home Infusion, and Home Sleep services.
20 Church Street,
12th Floor
Hartford, CT 06103
http://www.carecentrix.com
Overview:

The PAC Nurseis a telephonic position responsible for managing the length of stay (LOS) for Long Term Acute Hospital (LTACH), Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for their assigned post-acute care facilities through collaboration PAC Nursewill also collaborate with key facility personnel as well as with CareCentrix internal Medical Directors, Market Engagement Directors and Nurse Managers to develop and maintain a timely discharge plan.

Responsibilities:

  • For assigned 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.
  • 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.
  • Through the Supervisor, 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.

Supports the following additional duties as requested:

  • Participates in performance and operational improvement activities.
  • Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
  • Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
  • Participates in special projects and performs other duties as assigned.
  • Participates in an annual Inter-rater reliability Testing Process.
  • Typical work schedule is Monday thru Friday 8am to 6pm. Based on business needs, evening and weekend coverage may be needed at times.

Qualifications:

– Current and unrestricted license as a Licensed Practical Nurse or Registered Nurse. – Associate’s Degree or Diploma in Nursing/Practical Nursing or the equivalent – Minimum of 2 years clinical experience in a clinical setting – Expertise in Utilization Management and knowledge of URAC & NCQA standards. – Broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, Interqual). – Excellent negotiation, influencing, problem solving and decision making skills required. – Must have strong organizational skills and be able to effectively manage and prioritize tasks. – Works independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision. – Must have a strong commitment to quality and standards. � What we offer: – Comprehensive Health, Dental, and Vision plans with HSA Employer Contributions and Dependent Care FSA Employer Match – Generous PTO, 401K Savings Plan, Paid Parental Leave, and Tuition Reimbursement – Access to earned income between paychecks and financial support via PayActiv – Complimentary on-demand fitness, mindfulness, and nutrition via Wellbeats – Great culture with a sense of community, with career growth and development opportunities . � .

What we offer:
  • Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
  • Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
  • Advancement opportunities, professional skills training, and tuition Reimbursement
  • Great culture with a sense of community.
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.

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If you require alternative methods of application or screening, you must approach CareCentrix directly to request this, as we're not responsible for the employer's application process.

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