Remote Post Acute Clinical Review Nurse

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.

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. This role involves working closely with key facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.

Collaborate 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 you are assigned to obtain all clinical information required and proactively obtain patient status updates. Work alongside the Supervisor and 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. Conduct 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 to 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. Participate in performance and operational improvement activities. Contribute to ongoing quality assessment/improvement activities, ensuring the collection of data for improvement analysis and preparing 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. Maintain a typical work schedule with occasional evening and weekend coverage based on business needs.