PACE Enrollment Registered Nurse

Neighborhood Healthcare•Murrieta, CA

18h•Hybrid

About The Position

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together. Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community. As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants. The Registered Nurse (RN) Enrollment works to support the mission and vision of Neighborhood Healthcare (NHC) by providing outreach and enrollment services to patients for Neighborhood Healthcare’s Program for All-Inclusive Care for the Elderly (PACE). This role will follow leads for prospective PACE enrollees to complete assessments to determine eligibility into the program. In addition, this role will play a critical part in initiating the coordination of care for newly enrolled patients. This is a hybrid position that requires fieldwork conducting in-home assessments for PACE applicants. This position will cover our entire service area (Riverside County and South San Bernardino County).

Requirements

Associate's degree in nursing required
CA RN license required
Current Basic Life Support (BLS) certification though an American Heart Association (AHA)- Approved source is required upon hire and must be maintained as a condition of employment. AHA- approved courses include an in-person, hands-on skills check with a certified instructor using a mannequin to demonstrate CPR and emergency response techniques. Online-only BLS courses without a live skills check do not meet this requirement.
In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually
Valid CA driver’s license or out of state driver’s license for active military personnel/spouses required
Proof of auto insurance required
Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
Ability to take and pass the State of California DHCS PACE and Medi-Cal Marketing Certification exam within 60 days of hire
Ability to interact professionally and respectfully with geriatric individuals including those with cognitive decline and/or physical frailties
Ability to successfully manage multiple tasks simultaneously
Excellent planning and organizational ability
Ability to work as part of a team as well as independently
Ability to work with highly confidential information in a professional and ethical manner
Ability to lift/carry 50lbs/weight
Ability to stand for extended periods of time
Follow all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
Maintain current knowledge of policies and procedures as they relate to safe work practices
Use appropriate body mechanics to ensure an injury free environment
Be familiar with location of nearest fire extinguisher and emergency exits
Follow all infection control procedures including blood-borne pathogen protocols
Maintain privacy of all patient, employee and volunteer information and access such information only on a need-to-know basis for business purposes
Comply with all regulations regarding corporate integrity and security obligations
Report all behavior and/or activity that are unethical, fraudulent, or unlawful

Nice To Haves

Bachelor's degree in nursing preferred
Two years of clinical, outpatient, or general medicine experience preferred
Bilingual (English/Spanish) preferred
One year experience working with frail elderly populations is preferred
Knowledgeable about and experience with working in senior or elder care setting–PACE, Nursing Home, Hospice, ADHC preferred

Responsibilities

Responds to individual inquiries regarding PACE, including phone calls, web site inquiries, walk-ins, home visits, hospital, and nursing home visits
Provides tours of PACE centers to interested family members, potential participants, community partners, and providers
Reviews the enrollment process with potential enrollees, families, and referring parties
Provides detailed medical history and lifestyle assessments to applicants enrolling in PACE in-home and the PACE center
Provides referrals to other programs for individuals not appropriate for PACE and for those who choose not to enroll
Serves as the liaison for California Department of Health Care Services (DHCS) level of care (LOC) assessments
Assesses and documents patient statuses to support the regulatory reviews and approvals of initial enrollments (LOC for PACE)
Organizes and submits reporting information to DHCS, such first submission, resubmission, or deferral status for applicants or prospective enrollees
Coordinates with the intake team if additional applicant information is required
Monitors the statuses of DHCS submissions and coordinates with enrollment team
Conducts full medical and environmental in-home assessments on prospective enrollees
Coordinates with home care team when reassessments are required for applicants
Performs patient assessments to identify and address overt problems/needs; including priority setting, referrals and follow-ups, diagnostics review, medical record interpretation, and data collection to complete required forms for compliance
Participates on the Interdisciplinary Team (IDT) to provide information for enrollment decisions and ongoing communication with referral sources, potential enrollees, and families during the intake process
Creates initial care plans with participant during care planning stage with IDT
Completes appropriate documentation related to participant assessments as required
Prepares and oversees the semi-annual level of care on-site audits in coordination with other IDT members
Observes and reports changes in participants physical, mental, emotional, and social functioning to the IDT
Keeps informed of PACE eligibility requirements, general Medicaid eligibility guidelines, and supplemental insurance issues as they affect enrollment and the Medicare CMS regulation for PACE
Conducts clinical presentations, as required
Provides responsive and high-quality services to patients, team members, and outside organizations
Provides input and feedback on PACE’s internal and external outreach, education, and enrollment plan for engaging, assisting, enrolling, and retaining new and current enrollees