PACE Home Care Coordinator - Chula Vista (CNA/HHA Cert Required)

San Ysidro Health•Chula Vista, CA

115d•$27 - $34•Onsite

About The Position

The PACE Home Care Coordinator HHA is a collaborative member of the Interdisciplinary Team (IDT) and works under the supervision of the San Diego PACE Home Care Coordination RN Manager. The role provides foundational support to the Home Care Coordination team by conducting home safety evaluations and coordinating and monitoring IDT-approved services, including meal delivery, caregiver services, durable medical equipment (DME), and incontinence supplies. The coordinator advocates for participants’ healthcare needs and preferences and helps ensure that unskilled home-based care is coordinated in a person-centered, compassionate manner aligned with participants’ goals and preferences. The coordinator works closely with participants, families, healthcare providers, caregiver agencies, DME suppliers, and IDT members to coordinate schedules, monitor service delivery and quality, identify service gaps, and recommend care-plan adjustments. The position documents and tracks services in designated logs and participant electronic medical records (EMRs), supports PACE nurses, conducts participant visits, and performs related administrative and delivery duties. The role requires frequent travel to participant homes and SYH and San Diego PACE sites, as well as standing, walking, twisting, and occasionally lifting, pushing, or transferring participants weighing approximately 100 to 200 pounds.

Requirements

One year of experience with the frail or elderly population.
Certified Nursing Assistant (CNA) certificate and Home Health Aide (HHA) certificate.
Valid California driver’s license and vehicle insurance.
CPR and First Aid (BLS) certification from the American Heart Association.
Effective oral and written communication skills and ability to follow written and oral instructions.
Attention to detail when typing and proofreading materials.
Ability to communicate effectively and work collaboratively.
Basic computer skills, including Microsoft Suite, Outlook, and Excel.
Highly organized, responsive, and self-directed, with the ability to collaborate as a team member while executing tasks independently.
Skills necessary to coordinate and evaluate services for geriatric participants.
Firm understanding of the Home Health Aide scope of practice and ability to work within that scope.
Professional and personable demeanor to maintain excellent working relationships.
Strong organizational skills and excellent attention to detail.
Ability to solve problems and identify opportunities and potential challenges.
Ability to maintain confidentiality and discretion and deal effectively and tactfully with staff, patients, and the public.
Ability to meet pre-employment requirements, including I-9, physical, positive background and reference check results, completed application, new-hire orientation, and pre-employment PPDs.
Compliance with all mandated vaccinations and boosters as a condition of employment.
Ability to meet the physical demands of continuous standing, walking, and twisting; occasional lifting, pushing, and/or transferring participants weighing approximately 100 to 200 pounds; and exposure to health-related workplace elements such as accidents, injuries, and illness.
Ability to travel frequently to participant homes, SYH sites, and San Diego PACE sites.

Responsibilities

Coordinate IDT-approved meal delivery to participant homes.
Coordinate IDT-approved delivery of durable medical equipment and incontinence supplies to participant 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 in designated logs and participant EMRs in accordance with clinical, DHCS, and CMS regulations and guidelines.
Review progress notes and service-delivery documentation and inform the IDT of service gaps for reconciliation.
Upload progress notes, reports, and care- or vendor-related documentation to the EMR.
Communicate regularly with participants, families, and healthcare providers to support coordinated care delivery.
Advocate for participants’ healthcare needs and preferences and support person-centered, compassionate care.
Support SD PACE nurses in coordinating and delivering meals, DME, caregiver services, and other services.
Collaborate with physicians, social workers, therapists, and other interdisciplinary team members to coordinate participant care.
Follow infectious disease precautions to help prevent the spread of organisms.
Attend center staff meetings and in-service educational training programs.
Assist Home Care Coordination RNs as requested.
Conduct and document monthly visits for homebound and RCFE participants, and conduct home visits as needed.
Assist participants with surveys.
Deliver supplies, equipment, grocery bags, and other items as requested or needed.
Generate and maintain reports on services provided to participants.
Communicate and work effectively with participants and coworkers; participate in IDT meetings as needed.
Follow attendance and punctuality policies and established PACE and ADHC departmental and position-specific policies and procedures.
Attend required meetings and participate in committees as directed.
Maintain health and safety standards, participate in the Safety and Injury Prevention in the Workplace Program, and maintain required records and documentation.
Perform other related duties as assigned or requested.