PACE Enrollment Registered Nurse

Job Description

Job Description

About Us

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

The Registered Nurse (RN) Enrollment works to support the mission and vision of Neighborhood Healthcare (NHC) by providing outreach and enrollment services to patients for Neighborhood Healthcare’s Program for All-Inclusive Care for the Elderly (PACE). This role will follow leads for prospective PACE enrollees to complete assessments to determine eligibility into the program. In addition, this role will play a critical part in initiating the coordination of care for newly enrolled patients.

This is a hybrid position that requires fieldwork conducting in-home assessments for PACE applicants. This position will cover our entire service area (Riverside County and South San Bernardino County). Schedule: Monday-Friday, 8am-5pm. 

Responsibilities  

• Responds to individual inquiries regarding PACE, including phone calls, web site inquiries, walk-ins, home visits, hospital, and nursing home visits
• Provides tours of PACE centers to interested family members, potential participants, community partners, and providers
• Reviews the enrollment process with potential enrollees, families, and referring parties
• Provides detailed medical history and lifestyle assessments to applicants enrolling in PACE in-home and the PACE center
• Provides referrals to other programs for individuals not appropriate for PACE and for those who choose not to enroll
• Serves as the liaison for California Department of Health Care Services (DHCS) level of care (LOC) assessments
• Assesses and documents patient statuses to support the regulatory reviews and approvals of initial enrollments (LOC for PACE)
• Organizes and submits reporting information to DHCS, such first submission, resubmission, or deferral status for applicants or prospective enrollees
• Coordinates with the intake team if additional applicant information is required
• Monitors the statuses of DHCS submissions and coordinates with enrollment team
• Conducts full medical and environmental in-home assessments on prospective enrollees
• Coordinates with home care team when reassessments are required for applicants
• Performs patient assessments to identify and address overt problems/needs; including priority setting, referrals and follow-ups, diagnostics review, medical record interpretation, and data collection to complete required forms for compliance
• Participates on the Interdisciplinary Team (IDT) to provide information for enrollment decisions and ongoing communication with referral sources, potential enrollees, and families during the intake process
• Creates initial care plans with participant during care planning stage with IDT
• Completes appropriate documentation related to participant assessments as required
• Prepares and oversees the semi-annual level of care on-site audits in coordination with other IDT members
• Observes and reports changes in participants physical, mental, emotional, and social functioning to the IDT
• Keeps informed of PACE eligibility requirements, general Medicaid eligibility guidelines, and supplemental insurance issues as they affect enrollment and the Medicare CMS regulation for PACE
• Conducts clinical presentations, as required
• Provides responsive and high-quality services to patients, team members, and outside organizations
• Provides input and feedback on PACE’s internal and external outreach, education, and enrollment plan for engaging, assisting, enrolling, and retaining new and current enrollees

Qualifications

Education/Experience

• Associate's degree in nursing required
• Bachelor's degree in nursing preferred
• CA RN license required
• Current Basic Life Support (BLS) certification though an American Heart Association (AHA)- Approved source is required upon hire and must be maintained as a condition of employment.
  • AHA- approved courses include an in-person, hands-on skills check with a certified instructor using a mannequin to demonstrate CPR and emergency response techniques.
  • Online-only BLS courses without a live skills check do not meet this requirement.
  • In addition, current CPR and First Aid certification are required for all PACE employees in accordance with CMS and DHCS requirements. First Aid training will be provided at onboarding and must be renewed annually
• Valid CA driver’s license or out of state driver’s license for active military personnel/spouses required
• Proof of auto insurance required
• Two years of clinical, outpatient, or general medicine experience preferred
• Bilingual (English/Spanish) preferred
• One year experience working with frail elderly populations is preferred

Additional Qualifications (Knowledge, Skills and Abilities) 

• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with working in senior or elder care setting–PACE, Nursing Home, Hospice, ADHC preferred
• Ability to take and pass the State of California DHCS PACE and Medi-Cal Marketing Certification exam within 60 days of hire
• Ability to interact professionally and respectfully with geriatric individuals including those with cognitive decline and/or physical frailties
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements

• Ability to lift/carry 50lbs/weight
• Ability to stand for extended periods of time

COMPLIANCE (Safety & HIPAA)

• Follow all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintain current knowledge of policies and procedures as they relate to safe work practices
• Use appropriate body mechanics to ensure an injury free environment
• Be familiar with location of nearest fire extinguisher and emergency exits
• Follow all infection control procedures including blood-borne pathogen protocols
• Maintain privacy of all patient, employee and volunteer information and access such information only on a need-to-know basis for business purposes  
• Comply with all regulations regarding corporate integrity and security obligations
• Report all behavior and/or activity that are unethical, fraudulent, or unlawful

Neighborhood Healthcare offers a generous benefit plan that includes: Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more! 

Pay range: $45.91 - $67.93 per hour, depending on experience.

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.