Regional Medicaid Admissions & Quality Nurse

 Join PACS: Elevate Healthcare with Us!

PACS is elevating healthcare by revolutionizing our approach to leadership and quality care. Guided by our core values of love, excellence, trust, accountability, mutual respect, and commitment, we strive to foster a culture of compassionate care within our teams and the communities we serve. As we grow rapidly, exciting opportunities await you to engage in impactful projects and contribute valuable insights to stakeholders nationwide.

If you're ready to make a difference and embrace our mission of creating real change, we invite you to join us at PACS. Together, let’s shape the future of healthcare!

Join Our Team and Thrive!

At PACS, we believe our employees are our greatest asset. That’s why we offer an exceptional benefits package designed to enhance your well-being and support your lifestyle.

Our Comprehensive Benefits Include
 

• Health Coverage: Enjoy medical, dental, and vision plans to keep you and your family healthy.
• PTO and Vacation: Benefit from generous paid time off and holidays to relax and recharge.
• Financial Wellness: Take advantage of Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) to manage your healthcare expenses effectively.
• Retirement Planning: Secure your future with our 401(k) plan, complete with company contributions to help you build your retirement savings.
• Support When You Need It: Our Employee Assistance Plan (EAP) provides confidential support for personal and professional challenges.
   

Join us at PACS and take advantage of a workplace that truly values you!

General Purpose

This LPN-level role supports Medicaid admission workflows (PAE/PASRR) and tracks facility-level quality performance for TennCare programs, including VBP and QIP. The position focuses on documentation coordination, compliance tracking, and communication support across assigned SNFs.

Essential Duties and Responsibilities

Medicaid Authorization & Admission Coordination

• Assist in timely and accurate preparation of PAEs through the QSource portal for all TennCare applicants.
• Monitor status of Level of Care (LOC) determinations and track expiration/resubmission timelines.
• Support facility teams in gathering appropriate documentation for medical necessity and diagnosis alignment.
• Facilitate communication between social services and providers regarding PASRR Level I and Level II screenings.
• Track and report authorization delays or denials; escalate issues to appropriate clinical leadership.
• Maintain organized logs of submissions, follow-ups, and resolution timelines.

TennCare Facility Performance Tracking

• Provide basic training and ongoing support to facility teams on PAE/PASRR submission, documentation standards, and quality measure awareness related to TennCare QIP/VBP programs.
• Assist in monitoring performance metrics related to TennCare and MCO quality initiatives (e.g., rehospitalizations, psychotropic utilization, fall incidents).
• Collaborate with interdisciplinary teams on data collection needed for QAPI and compliance reviews.
• Provide clerical and coordination support for internal audits and Medicaid documentation reviews.
• Support education efforts by distributing standardized materials and assisting with follow-up monitoring.

Data Reporting & Regional Communication

• Compile data summaries for PAE/PASRR tracking and assist in generating monthly performance dashboards.
• Coordinate with facility staff to ensure timely UR/CSR review preparation.
• Help maintain consistency of documentation workflows aligned with TennCare and MCO reporting expectations.

Key Performance Indicators (KPIs)

• Timely tracking and follow-up on all PAE and PASRR submissions
• Reduction in authorization delays due to documentation gaps
• Accurate maintenance of compliance logs and quality tracking tools
• Completion of data summaries to support facility Medicaid-related performance reviews

Qualifications

• Licensed Practical Nurse (LPN), licensed in the State of Tennessee (required)
• At least 2 years of experience in skilled nursing facility admissions, Medicaid coordination, or medical records
• Familiarity with TennCare LTSS, QSource PAE portal, and PASRR requirements
• Working knowledge