Regional Medicaid Admissions & Quality Nurse (LPN)
About The Position
This position is focused on the coordination, tracking, and monitoring aspects of Medicaid admissions and facility performance, within the scope of LPN practice under Tennessee regulations. Duties and responsibilities listed in this description are subject to change or redirection at the discretion of leadership based on operational needs. Clinical decision-making and regulatory interpretations are escalated to appropriate licensed staff (RN or administrative leadership). PACS is revolutionizing the delivery and leadership of post-acute healthcare and support services across the country. Originally founded in 2013, the organization now consists of hundreds of independent operating subsidiaries, as well as ancillary and support services. We bring a proven model of mission-driven care that balances access to a national network of support and resources with local decision making. In addition, PACS helps connect exceptional people with premier healthcare careers across the country. We focus on finding innovative and effective team members based on their qualifications, experience, geographic preferences, and personality fit with the existing facility staff and culture. We celebrate diversity and are committed to creating an inclusive environment for all employees. We welcome applicants of every race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, and any other protected characteristic. Employment decisions are based on qualifications, merit, and business needs.
Requirements
- 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 of EMR systems and Microsoft Office applications
- Strong organizational skills and attention to detail
- Ability to communicate effectively with interdisciplinary teams and external partners
Responsibilities
- 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.
- 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.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
