Job Summary

A company is looking for a PAC Nurse.

Responsibilities:

• 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

Qualifications:

• Hold a current and unrestricted license as a Licensed Practical Nurse or Registered Nurse
• Have Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent
• Possess a minimum of 2 years clinical experience in a clinical setting
• Be an expert in Utilization Management and knowledge of URAC & NCQA standards
• Have a broad knowledge of health care delivery/managed care regulations and experience with evidence based care guidelines (i.e. MCG/Milliman, InterQual)