Posted on: January 27, 2023
Job ID: 2022-14280
Type: Regular Full-Time
# of Openings: 1
Category: Clinical / Post Acute Care
The PAC Nurse is 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
Nurse will 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
In this role, you will:
- 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
- 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
- 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
- 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
- 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.Support the following additional duties as
- Participate in performance and operational improvement
- Participate in and contribute to ongoing quality
assessment/improvement activities, ensures the collection of data
for improvement analysis and prepares 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
- Participate in an annual Inter-rater reliability Testing
- Schedule options vary with this role based on business needs,
currently we need nurses willing to work weekend schedules.
You should reach out if:
- You hold a current and unrestricted license as a Licensed
Practical Nurse or Registered Nurse.
- You have Associate's Degree or Diploma in Nursing/Practical
Nursing or the equivalent
- You possess a minimum of 2 years clinical experience in a
- You are an expert 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 excellent negotiation, influencing, problem solving
and decision making skills required.
- You possess organizational skills and are able to effectively
manage and prioritize tasks.
- You can work independently, utilizing sound clinical judgment
and critical thinking skills under minimal supervision.
- You must have a strong commitment to quality and standards.
What we offer:
- Salary Range: $32.00 - $36.00 / hour plus Annual Corporate
- Full range of benefits including Health, Dental and Vision with
HSA Employer Contributions and Dependent Care FSA Employer
- Generous PTO, 401K Savings Plan, Paid Parental Leave, free
on-demand Virtual Fitness Training and more.
- Advancement opportunities, professional skills training, and
- Great culture with a sense of community.CareCentrix maintains a
drug-free workplace.#IDCCWe 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.
Please see job description
Keywords: CareCentrix, Stamford , PAC Nurse, Healthcare , Stamford, Connecticut
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