PACE Home Care Coordinator - Vista Region (Must have CNA & HHA)

San Ysidro Health•Vista, CA

2d•Hybrid

About The Position

The PACE Home Care Coordinator - Vista Region, under the supervision of the San Diego PACE Home Care Coordination RN Manager, provides essential support to the Home Care Coordination team. This role involves conducting home safety evaluations, coordinating and monitoring services approved by the Interdisciplinary Team (IDT) such as meal delivery, caregiver services, and durable medical equipment (DME) for SD PACE participants. The Home Care Coordinator HHA acts as an advocate for participants' healthcare needs and preferences, ensuring care is delivered in a person-centered and compassionate manner. They work closely with participants, their families, and the IDT to coordinate all aspects of unskilled home-based care, aligning with participants' goals and preferences. This includes liaising with caregiver agencies and DME suppliers to schedule services, monitor delivery and quality, and recommend adjustments to care plans.

Requirements

One year of experience with the frail or elderly population.
CNA (Certified Nursing Assistant) and HHA (Home Health Aid) Certifications.
CNA Certificate.
Valid CA driver's license and vehicle insurance.
CPR and First Aid (BLS) certification from the American Heart Association.
Effective oral and written communication skills and the ability to follow written and oral instructions.
Attention to detail when typing and proofing materials.
Ability to communicate effectively and work collaboratively.
Basic computer skills including Microsoft Suite, Outlook, and Excel.
Highly Organized, highly responsive, takes initiative, ability to work collaboratively as a member of the team while independently executing tasks.
Must possess the skills necessary to coordinate and evaluate services for geriatric participants.
Must have a firm understanding of the Home Health Aide scope of practice and operate only within scope.
Professional and personable demeanor to maintain excellent working relationships.
Strong organizational skills with excellent attention to detail.
Ability to solve problems and identify both opportunities and potential challenges.
Maintain confidentiality and discretion and deal effectively and tactfully with staff, patients, and the public.
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.
Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

Responsibilities

Coordinate IDT approved meal delivery to client homes.
Coordinate IDT approved Durable Medical Equipment and incontinence supply delivery to client homes.
Coordinate IDT approved caregiver services for participants.
Complete the Home Care Coordination care plan at enrollment and semi-annually thereafter as a member of the IDT.
Conduct pre-enrollment, annual, semi-annual, and change of address home safety evaluations.
Document and track actions, services, and service delivery status updates in designated logs and participant electronic medical records (EMR) in accordance with clinical, DHCS, and CMS regulations and guidelines.
Review progress notes and documentation of the delivery of services, informing the IDT of any gaps in service for reconciliation.
Upload progress notes, reports and care/vendor related documentation to the EMR.
Communicate regularly with participants, their families, and other healthcare providers to ensure coordinated care delivery.
Advocate for participants' healthcare needs and preferences and ensuring that care is delivered in a person-centered and compassionate manner.
Provide support to SD PACE nurses in the coordination and delivery of meals, DME, caregiver services, etc.
Collaborate with the interdisciplinary team members, including physicians, social workers, therapists, and other healthcare professionals, to ensure coordinated care for participants.
Adhere to infectious disease precautions to prevent the spread of organisms.
Attend center staff meetings and in-service educational training programs.
Assist Home Care Coordination RN’s as requested.
Conduct and document monthly visits for homebound and RCFE participants.
Conduct home visits as needed.
Assist participants with surveys.
Deliver supplies, equipment, grocery bags, and any other items as requested/needed.
Generate and maintain reports on services provided for the participants.
Communicate and work effectively with participants and co-workers.
Participate in interdisciplinary team meetings as needed.
Adhere to SYHC and PACE attendance and punctuality policies and practices.
Follow established PACE and ADHC departmental and position specific policies and procedures.
Attend meetings as required and participate in committees as directed.
Maintain health and safety standards and take an active role in the Safety and Injury Prevention in the Workplace Program; maintain all records and documentation as required.
Perform other related duties as assigned or requested.