Senior PACE Resource & Care Coordination RN

San Ysidro Health; San Diego (CA); On-site; USD 110,000 - 150,000; Full time

Job summary

San Ysidro Health is seeking a Senior PACE Resource Management Registered Nurse to oversee non-acute resource management, care coordination, and utilization review for PACE participants.

The role involves retrospective and prospective reviews, collaboration with the Medical Director and IDT, and implementing resource management projects to improve outcomes and contain costs within the San Diego PACE program.

Qualifications

• Minimum of 3 years RN experience in outpatient, hospital, PACE, or resource utilization.
• Knowledge of PACE regulations (state and federal).
• Experience with care coordination and utilization management concepts.

Responsibilities

• Perform retrospective and prospective reviews for medical necessity and appropriateness.
• Coordinate with the IDT and CMO to plan and monitor patient care and resource use.
• Develop and implement resource management plans to improve outcomes and reduce costs.

Skills

Analytical skills

Communication skills

Care coordination

PACE regulations knowledge

Education

Graduate of an accredited registered nursing program

ASN/BSN preferred

Tools

EPIC EMR

InterQual

QuickCap

Job description

San Ysidro Health is seeking a Senior PACE Resource Management Registered Nurse to oversee non-acute resource management, care coordination, and utilization review for PACE participants.

The role involves retrospective and prospective reviews, collaboration with the Medical Director and IDT, and implementing resource management projects to improve outcomes and contain costs within the San Diego PACE program.