PACE Care Coordinator RN (Central Valley PACE - Modesto)

Available Staff Positions•Modesto, CA

1d•Onsite

About The Position

Under the supervision of the Medical Director and Clinical Supervisor, the PACE Care Coordinator RN provides clinic nursing services, including assessing participants, participating in the interdisciplinary team and care planning, implementing care and case management, evaluating participant care and medical records, and providing clinical leadership. The role works with participants, families, caregivers, physicians, and the interdisciplinary team to coordinate participant care and services. 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

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.
One year of experience in a home health agency, primary care clinic, or health facility as a registered nurse or licensed vocational nurse, or at least five years of experience as a CNA or MA.
At least one year of experience working with the frail or elderly population.
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, with excellent written and verbal communication skills and the ability to maintain accurate records.
Ability to facilitate effective meetings and provide excellent customer service.
Knowledge of health characteristics affecting frail or elderly populations, 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.
Skill in establishing and maintaining effective working relationships with participants, coworkers, medical staff, and the public.
Skill in identifying problems and recommending resolutions.
Knowledge of healthcare facility safety and infection-control requirements.
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 required.
Maintain professional affiliations and any required certifications.

Responsibilities

Demonstrate effective communication and problem-solving skills.
Support Golden Valley Health Centers’ mission, vision, values, and strategy by providing participant-centered treatment, care, and services.
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, identify problems and needs, set priorities, and communicate changes in participants’ conditions.
Assist with care planning in coordination with the interdisciplinary team, participant, family, and caregiver, and evaluate participant care measures.
Record observations related to impending or associated 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, procedures, and use of internal and external care services; collaborate internally regarding shared panels and service utilization.
Provide interventions that expand services in coordination with the physician’s provision of 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 electronic medical record.
Track no-shows and coordinate with the care coordination team and interdisciplinary team as appropriate.
Coordinate participant admissions to PACE-contracted hospitals and work with the Utilization Management team on discharges from hospitals or skilled nursing facilities.
Collaborate with quality and Utilization Management teams on quality measures and reports.
Track outside medical appointments, radiology orders, and laboratory orders and 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 the visit.
Provide clinical supervision to the care team, including mentoring and delegating to appropriate personnel such as LVNs and PCAs in coordination with treatment and procedures.
Participate in quality improvement processes and comply with policies and procedures for safe work practices.
Maintain, administer, and reconcile medication.
Interact professionally and respectfully with geriatric individuals, including those with cognitive decline or physical frailty.
Observe participants for changes in physical, mental, emotional, or social functioning and report changes to the interdisciplinary team.
Perform other projects and duties as assigned.