Title - Public Health Nursing Consultant 1
Location : Nashville, Tennessee 37243
Duration : 10+ Month’s contract with the possibility of extension
Shift hours : 8 am to 4.30pm
LTSS Ops PHNC for M.S.

Job Title: Public Health Nursing Consultant 1

**This is a onsite position - only candidates in middle Tennessee and able to commute to Nashville, TN regularly will be considered.**

The standard work week is 37.5 hrs./wk.

The LTSS Operations team is requesting a contractor to assist with nurse related functions for LTSS programs. This includes making eligibility determinations for applicants in a way that aligns with TennCare Rule and level of care (LOC) requirements for Nursing Facility LOC and At Risk LOC. Assist with data entry into newly implemented eligibility system. The new eligibility system implementation of PERLSS has increased the workload of existing team members and additional support is needed to maintain daily functions of the PHNC team to ensure LOC determinations are handled timely and accurately. The contractor role will allow the PHNC team members to manage PERLSS related work, including monitoring and reporting defects, process improvements, and required work related to additional PERLSS implementation phases.

Description of Duties (PROJECT-BASED) % of Total Work Effort

• PAE Adjudication functions: Review submitted PAEs, Medicaid medical eligibility applications, for level of care determinations for approval or denial for LTSS programs utilizing clinical expertise. Decisions must be made in accordance with TennCare Rule. Ensure compliance with Federal PASRR regulations with adjudicating PAEs for CHOICES program, specific to those seeking to resident and receives services in a nursing facility. This also includes adjudicating skilled service requests, Enhanced Respiratory Care request, safety requests, and target population decisions. 70%
• Transcribe approved PASRR determinations from the TMED system into the PERLSS system to allow for additional enrollment and eligibility actions to be taken on completed records. 30%

Action Plan Timeline

The contractor will be needed for 12 months.

• Months 1-2: Training on new role, including shadowing and completion of new hire onboarding process.
• Month 3: The contractor will begin working independently, with hands on support and monitoring of supervisor, on PHNC 2 related tasks. These include determining LOC for applicants and entering data into the eligibility system. Weekly check ins to occur with supervisor to monitor productivity and answer questions.
• Months 4-10: The contractor will be fully independent in role and providing support with appeal tasks. This will also include providing required reports, as needed, to supervisor. In months 9 and 10, the supervisor and contractor will begin discussing transition plan for tasks, to include a review of eligibility system implementation related tasks that are close to completion or have already been completed.
• Months 11-12: The contractor will work with the PHNC team on transitioning responsibilities to team members and finalizing outstanding work tasks. The contractor and supervisor will create a transition plan to minimize transition related gaps, ensuring compliance to Rules and required timeframes for LOC determinations.

Minimum qualifications

• Graduation from an accredited college or university with a bachelor’s degree in nursing and experience equivalent to four years of full-time increasingly responsible professional nursing work
• Excellent verbal and written communications skills
• Proven technical skills (e.g. Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, etc.)
• Excellent time management skills and ability to multi-task and prioritize work in order to meet specific timeframes anddeadlines with minimal supervision
• Keen attention to detail and adherence to deadlines
• Organization
• Self-motivated and able to thrive in a fast-paced and results-driven environment
• Critical thinking and problem-solving skills

Job Type: Contract

Salary: $20.18 - $29.62 per hour

Schedule:

• 8 hour shift

Ability to commute/relocate:

• Nashville, TN 37243: Reliably commute or planning to relocate before starting work (Required)

Work Location: One location

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