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

Golden Valley Health Centers•Stockton, CA

1d•$50 - $58

About The Position

The PACE Level of Care Clinic RN conducts level-of-care assessments to determine participant eligibility and provides clinic nursing services. Based in Stockton, the role includes initial training at the Modesto Center and operates Monday through Friday, 8:00 a.m. to 5:00 p.m. The RN works under the clinical supervision of the PACE Center Manager RN and supports Golden Valley Health Centers’ mission, vision, values, and strategy through patient-centered care and services. The position serves as the liaison for California Department of Health Care Services (DHCS) level-of-care assessments, completes in-home medical and environmental assessments for prospective enrollees, and submits required documentation to DHCS. The RN collaborates with the interdisciplinary team (IDT) on assessments and care planning, delivers and evaluates nursing care, educates participants and caregivers, coordinates referrals and emergency services as appropriate, and contributes to audits, quality improvement, and clinic leadership activities. The role also requires professional and respectful interaction with geriatric participants, including those with cognitive decline or physical frailties, and reporting changes in their functioning to the IDT.

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.
At least one year of experience as a registered nurse; home or community health experience is preferred.
At least one year of experience working with frail or elderly people.
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.
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.
Ability to identify problems and recommend resolutions.
Knowledge of healthcare facility safety and infection-control requirements.
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.
Comfort completing assessments routinely in participants’ residences.
Successfully complete DHCS level-of-care training within three months of hire.
Ability to interact professionally and respectfully with geriatric individuals, including those with cognitive decline or physical frailties.

Nice To Haves

Preferably, at least one year of registered-nurse experience in home or community health.

Responsibilities

Serve as the liaison for California Department of Health Care Services (DHCS) level-of-care assessments.
Conduct full medical and environmental in-home assessments on prospective enrollees.
Complete level-of-care documentation and submit it for state review initially and as required annually.
Prepare and oversee semi-annual level-of-care on-site audits in coordination with interdisciplinary team members.
Present prospective enrollee cases to the interdisciplinary team as needed.
Develop plans of care with the interdisciplinary team based on nursing assessments and the participant’s immediate and ongoing needs, incorporating participant and family perspectives.
Educate participants, family members, and caregivers about disease processes, self-care techniques, and prevention strategies.
Provide community resources and referrals as needed before enrollment.
Identify emergency situations and take appropriate action, including coordinating emergency services from the home when appropriate.
Assess patient problems and needs, set priorities, identify issues requiring referral or follow-up, interpret and record diagnostic results, conduct advanced nursing assessments, and complete required forms according to clinic standards.
Participate in the interdisciplinary team and care-planning process, including initial and semiannual assessments; involve participants, families, and caregivers; make referrals to support services; and communicate participant changes to the team.
Provide care in accordance with accepted practice standards, perform prescribed treatments and procedures, provide health education, participate in 24-hour care, initiate advanced therapy in emergencies, coordinate care with other health personnel, and respect patient rights and ethical care processes.
Record care delivered and variations from the plan, observe and document impending or associated problems, and implement related nursing measures.
Delegate nursing care appropriately, identify and document clinic problems, participate in quality improvement, follow safe-work policies, recognize and address inefficient care management, complete written reports, fulfill clinic call assignments, and adjust workflows for census and acuity.
Observe participants for changes in physical, mental, emotional, and social functioning and report changes to the interdisciplinary team.
Perform other projects and duties as assigned.