PACE Level of Care Clinic RN (Central Valley PACE - Stockton)

Golden Valley Health Centers•Stockton, CA

7d•$50 - $58•Hybrid

About The Position

Under the clinical supervision of the PACE Center Manager RN, this role conducts level of care (LOC) assessments to determine participant eligibility. The RN provides clinic nursing services, including assessing patients, participating in the interdisciplinary team and care planning, implementing care and care management, evaluating patient care and medical records, and demonstrating leadership abilities. Until the Stockton location is operational, the role will be based and trained at the Modesto center. The schedule is Monday - Friday, 8:00 am - 5:00 pm.

Requirements

Valid CA Driver’s License, acceptable driving record, and vehicle insurance.
Ability to lead and supervise effectively.
Ability to work under stressful conditions.
Creative, detailed-oriented and organized.
Excellent written and verbal communication skills with specific ability to maintain accurate records.
Ability to facilitate effective meetings.
Excellent customer service skills.
Must have integrity, practice discretion and practice objective problem solving.
Data collection skills and knowledge of basic statistical principles.
Skilled in establishing and maintaining effective working relationships with participants, coworkers, medical staff, and the public.
Skilled in identifying and recommending problem resolution.
Knowledge of safety and infection control requirements for healthcare facilities.
Demonstrated experience in quality assurance and performance improvement activities and in the development and implementation of staff education with application of adult learning concepts.
Proficient in Microsoft Office applications; advanced Microsoft Excel experience required.
Maintains professional affiliations and any required certifications.
Comfort with completing assessments routinely in the participant’s residence.
Successfully complete level of care training from DHCS within three months of hire in the position.
High school diploma or equivalent.
Graduate of an accredited school of professional registered nursing.
Current unencumbered CA Registered Nurse (RN) License.
Current BLS CPR Card certified by American Heart Association.
Minimum one (1) year as a Registered Nurse, preferably in either home or community health.
Minimum one (1) year experience working with the frail or elderly population.

Responsibilities

Conducts level of care (LOC) assessments to determine participant eligibility.
Provides clinic nursing services including assessing patients.
Participates in the interdisciplinary team and care planning.
Implements care and care management.
Evaluates patient care and medical records.
Demonstrates leadership abilities.
Serves as the liaison for California Department of Health Care Services (DHCS) LOC assessments.
Conducts full medical and environmental in-home assessments on prospective enrollees.
Completes level of care documentation and submits for state (DHCS) review initially and annually.
Prepares and oversees the semi-annual level of care on-site audit in coordination with other interdisciplinary team members.
Presents prospective enrollee cases to the Interdisciplinary team as needed.
Develops a plan of care based on nursing process that incorporates immediate and continuing care needs and includes the participant and family perspective.
Educates the participant, family members, and/or caregiver regarding disease process, self-care techniques, and prevention strategies.
Provides community resources and referrals as necessary prior to enrollment.
Identifies emergency situations and takes appropriate action, including coordinating emergency services from home.
Assists Interdisciplinary team with forming a plan of care based on nursing evaluation.
Identifies patient’s overt problems/needs and sets priorities.
Identifies problems requiring further referral and follow-up.
Interprets and records latest diagnostic results.
Performs advanced nursing assessments using critical thinking skills.
Collects data and completes required forms with appropriate responses according to clinic standards.
Participates as a member of the IDT.
Assists with the care planning process in coordination with the IDT.
Includes the participant/family/caregiver in the care planning process.
Makes referrals to interdisciplinary support services.
Participates in IDT initial and semiannual assessments.
Communicates participant changes to IDT.
Provides care conforming to accepted practice standards.
Provides correct treatments/procedures as prescribed.
Demonstrates age-related characteristics and needs of Participants.
Provides participant health education.
Participates in twenty-four (24) hour care.
Identifies emergency situations and independently initiates advanced therapy.
Acts as coordinator of patient care with other health care personnel and evaluates patient care measures.
Understands and respects patient rights and utilizes established mechanisms for management of ethical issues in patient care.
Records patient care delivered as planned and any variation.
Makes and records observations related to impending or associated problems.
Implements nursing measures related to impending or associated problems.
Delegates nursing care to appropriate personnel.
Recognizes clinic problems and documents same.
Demonstrates participation in QI processes.
Complies with policies regarding safe working practices.
Recognizes inappropriate or inefficient patient care management.
Resolves issues/problems and completes written reports.
Fulfills call for clinic as assigned and adjusts work flows for census and acuity.
Interacts professionally and respectfully with geriatric individuals including those with cognitive decline and/or physical frailties.
Observes each participant for any change in physical, mental, emotional and social functioning and reports such changes to the Interdisciplinary Team.
Other projects and duties as assigned.