Public Health Nursing Consultant

Company: Careerbuilder-US
Location: Nashville
Posted on: May 29, 2023

Job Description:

Public Health Nursing Consultant 1
Job ID: 60202
Client: TN TennCare
Location: 310 Great Circle Rd. Nashville, Tennessee, 37243 (Onsite)
Duration: 15 + Months
Shift: 8:00 AM to 4:30 PM
Job Description:

- 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 the 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 the 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, and Medicaid medical eligibility applications, for the 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 te residence and receiving services in a nursing facility. This also includes adjudicating skilled service requests, Enhanced Respiratory Care requests, safety requests, and target population decisions. 70%
- Transcribe approved PASRR determinations from the TMED system into the PERLSS system to allow for additional enrolment and eligibility actions to be taken on completed records. 30%

Keywords: Careerbuilder-US, Nashville , Public Health Nursing Consultant, Healthcare , Nashville, Tennessee