Enrollment RN

High Desert PACE; Victorville (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

High Desert PACE seeks an Eligibility RN to determine participant eligibility for the PACE program. You will work with physicians, social workers and outreach and enrollment teams to assess care needs and plan home visits and center-based appointments.

You will perform nursing assessments, document findings for state review, and coordinate with the IDT to ensure timely eligibility decisions and compliance with DHCS guidelines. A strong geriatrics background is essential.

Qualifications

• Associate degree from accredited nursing program required.
• Current RN license in the state of work.
• Current CPR certification or ability to obtain CPR.
• 3 years healthcare experience with emphasis in geriatrics.
• 1 year working with frail or elderly individuals.

Responsibilities

• Enrollment RN collaborates with physician, social worker and outreach teams.
• Perform home visits and center-based assessments for eligibility.
• Assess level of care and determine eligibility per Title 22 guidelines.
• Document assessments and submit for DHCS review.
• Coordinate with IDT and outreach teams for timely care.
• Manage annual level-of-care reviews and audits.

Skills

Frail elder care knowledge

Nursing assessment

Interdisciplinary teamwork

Communication skills

Privacy & confidentiality

Organizational skills

Electronic records proficiency

Education

Associate degree

RN license

CPR certification

3 years healthcare experience

Geriatrics experience

Job description

Job Summary

Works under the general supervision of the Marketing, Enrollment and Network Director, The Eligibility RN works together with the Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the High Desert PACE Program.

Description

Works under the general supervision of the Marketing, Enrollment and Network Director, The Eligibility RN works together with the Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the High Desert PACE Program.

Requirements

Responsibilities

• The Enrollment RN is a member of the outreach and enrollment team, who works closely with the physician, social worker as well as other outreach and enrollment team members
• Physical attendance at the High Desery PACE facility and/or a High Desert PACE participant home is essential to performing the job duties
• Works closely with the Business Development and Enrollment Development Department to determine if prospective PACE participants meet Title 22 Guidelines for Nursing Level of Care, required for all PACE participants.
• Schedules and conducts home visits and/or center-based clinic appointments, to make level of care assessments to determine eligibility
• Conduct initial nursing assessments, including but not limited to nursing evaluation, functional assessment, and home safety evaluation, in prospective High Desert PACE participants' homes, to determine if they meet PACE eligibility requirements
• Promptly prepare documentation from home visits, submit to CA State Level-of-Care (LOC) nurse for review and reply to questions to expedite the review process for participants
• Track and oversee the annual State level-of-care review process
• Collaborate with the interdisciplinary team (IDT) and outreach & enrollment (O&E) team
• Protect privacy and maintain confidentiality of all company procedures and information about team members, participants, and families!
• Completes eligibility referral document, in close collaboration with the Organization’s Primary Care Physician, and compiling supporting documentation for application to the State for enrollment.
• Works closely with the California Department of Health Care Services (DHCS) PACE Nurse Assessor to make eligibility decisions about prospective new PACE participants
• Managing semi-annual audits of participant’s medical records conducted by the DHCS PACE Nurse Assessor
• Completes semi-annual level of care redetermination for all participants to be submitted to the DHCS PACE Nurse Assessor
• Supports and participates in business development and census growth process by being part of the Business Development Department
• Participates and assists with outreach programs
• Collaborate with the Interdisciplinary Team (IDT), and coordinate appointments for prospects that require further assessments by other IDT members.
• Participates in case management of peer review of client records and provides consultation to case managers and other staff members regarding medical and nursing issues

Education & Training

• Associate degree from accredited nursing school required.
• Current Registered Nurses License in state in which working
• Current CPR certification or the ability to obtain CPR certification
• 3 years health care experience with emphasis in geriatrics
• 1 year working with the frail or elderly

Skills & Abilities

• Knowledge of physical, mental and social needs of frail older adults.
• Effective skills in physical assessment and chronic disease management for frail older adults.
• Effective listening and oral and written communication skills.
• Demonstrated ability to work effectively within the interdisciplinary team setting.
• Computer proficiency.
• Able to manage changing priorities per participant needs.
• Strong organizational skills.
• Demonstrates necessary skills and knowledge as outlined in the position-specific Competency Assessment Profile.

Working Conditions

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work required schedule.
• Physical attendance at the High Desery PACE facility and/or an High Desery PACE participant home is essential to performing the job duties
• Requires use of personal vehicle.
• Requires valid driver’s license.
• Requires proof of automobile insurance coverage at the following minimum amounts to be reimbursed for mileage.
• May require use of personal cell phone for business purposes (may be eligible for stipend).