PACE Care Coordinator RN (Central Valley PACE - Modesto)

Golden Valley Health Centers • Modesto, CA

2d • $50 - $58 • Onsite

About The Position

Under the supervision of the Medical Director and Clinical Supervisor, the PACE Care Coordinator RN provides clinic nursing services, including participant assessment, participation in interdisciplinary care planning, implementation of care and case management, evaluation of participant care and medical records, and clinical leadership. The role supports participant-centered treatment and services for a frail or elderly population and works closely with participants, families, caregivers, physicians, and the interdisciplinary team.

The position is in the Clinic department and is scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m. Compensation is $49.92–$57.79 per hour.

Requirements

• Valid California driver’s license, acceptable driving record, and vehicle insurance.
• Ability to lead and supervise effectively and work under stressful conditions.
• Creative, detail-oriented, and organized approach to work.
• Excellent written and verbal communication skills, including the ability to maintain accurate records and facilitate effective meetings.
• Excellent customer service skills.
• Knowledge of health characteristics affecting frail or elderly populations.
• Knowledge of participant rights and established mechanisms for managing ethical issues in participant care.
• Integrity, discretion, and objective problem-solving skills.
• Data collection skills and knowledge of basic statistical principles.
• Ability to establish and maintain effective working relationships with participants, coworkers, medical staff, and the public.
• Skill in identifying problems and recommending resolutions.
• Knowledge of safety and infection-control requirements for healthcare facilities.
• Demonstrated experience in quality assurance and performance improvement activities and in developing and implementing staff education using adult-learning concepts.
• Proficiency in Microsoft Office applications; advanced Microsoft Excel experience is required.
• Maintain professional affiliations and any required certifications.
• High school diploma or equivalent.
• Graduate of an accredited school of professional registered nursing.
• Current, unencumbered California Registered Nurse (RN) license.
• Current BLS CPR card certified by the American Heart Association.
• At least one year of experience as a registered nurse or licensed vocational nurse in a home health agency, primary care clinic, or health facility; alternatively, at least five years of experience as a CNA or MA.
• At least one year of experience working with the frail or elderly population.

Responsibilities

• Assess participants using critical thinking and advanced nursing skills.
• Make internal and external referrals, follow up, and interpret and record diagnostic results.
• Participate in the interdisciplinary care team (IDT), identify problems and needs, set priorities, and communicate changes in participants’ conditions.
• Assist with care planning in coordination with the IDT, participant, family, and caregiver, and evaluate participant care measures.
• Record observations related to actual or impending problems and implement appropriate nursing measures.
• Provide care, treatments, and procedures in accordance with accepted practice standards and prescriptions.
• Identify emergency situations and independently initiate advanced therapy.
• Run daily participant-panel reports to coordinate treatment and preventive services and use of internal and external care services.
• Collaborate internally on shared participant panels and service utilization.
• Provide interventions that expand services in conjunction with physician-provided services and management of participant care.
• Provide or coordinate procedures and tests coded through separate non-E&M HCPCS codes; review physician progress notes to ensure recommendations have corresponding orders in the EMR.
• Track no-shows and work with the care coordination team and IDT as appropriate.
• Coordinate participant admissions to PACE-contracted hospitals.
• Coordinate with the Utilization Management team on participant discharges from hospitals or skilled nursing facilities.
• Collaborate with the quality and Utilization Management teams on quality measures and reports.
• Track outside medical appointments, radiology orders, and laboratory orders to ensure follow-up in accordance with policy standards.
• Document assessments, procedures, participant education, evaluations, visits, interventions, participant responses, treatment plans, and communications with physicians at the time of visits.
• Provide clinical supervision of the care team, including mentoring and delegating to appropriate personnel such as LVNs and PCAs, in coordination with treatment and preventive services.
• Participate in quality improvement processes and comply with policies and procedures for safe working practices.
• Maintain, administer, and reconcile medication.
• Interact professionally and respectfully with geriatric individuals, including people with cognitive decline or physical frailties.
• Observe participants for changes in physical, mental, emotional, or social functioning and report changes to the IDT.
• Demonstrate effective communication and problem-solving skills and support Golden Valley Health Centers’ mission, vision, values, and strategy by providing excellent participant-centered care and services.
• Perform other projects and duties as assigned.

Benefits

• Medical coverage with a $0 deductible and $2,000 individual/$4,000 family out-of-pocket maximum.
• PPO coverage.
• Dental coverage.
• Vision coverage.
• 403(b) plan with employer match.
• Flexible spending account (FSA) plans.
• Gym discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree