Regional Medicaid Admissions & Quality Nurse (LPN)

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.

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 of EMR systems and Microsoft Office applications

· Strong organizational skills and attention to detail

· Ability to communicate effectively with interdisciplinary teams and external partners

Physical Demands & Work Environment:

· Regional travel to SNFs as needed (up to 50%)

· Remote tracking and clerical support functions when not in facilities

· Must maintain HIPAA compliance and data confidentiality.

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

Note: 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).

Salary Range: $55,000- 60,000

We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other legally protected status.