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Utilization Management Nurse
2 months ago
PAC Nurse - Utilization Review Job Description
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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.
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Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and helping to clarify referral source directives.
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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.
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Work alongside the Supervisor and Market Engagement Directors to efficiently address potential facility concerns, pushback, or gaps in the process.
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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.
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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.
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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.
Hard Skills
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2 years of concurrent review experience and discharge planning
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2 years of utilization review/management experience
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Active RN license and compact/ multi-state
Job Type
This is a Contract-to-Hire position with a duration of 12 Month(s).
Work Site
This is a fully remote position. Equipment is provided. The first 8 weeks are training- you cannot miss any training days. The training schedule is Monday-Friday, 8am-4:30pm EST. Post-training, the schedule becomes Sunday-Thursday, 11am-8pm EST.
About Actalent
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.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
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Hiring diverse talent
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Maintaining an inclusive environment through persistent self-reflection
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Building a culture of care, engagement, and recognition with clear outcomes
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Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.
