Registered Nurse, PACE Enrollment

Impact Lives, Impact Community

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country. With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

Job Roles

Accompany Business Development Representative to initial home contact meeting. Evaluate for safety and stability of home environment and assess that prospective participant is appropriate for PACE using established criteria and guidelines.
Determine if prospective participant is currently enrolled in any State funded programs that would preclude them from enrolling in PACE including but not limited to SD County in-home support service (IHSS) and DMH programs.
Educate potential participant that they are not eligible to be submitted for PACE until they are disenrolled in any disqualifying state programs. Provide alternative resources if available.
Present prospective participants to interdisciplinary team (IDT) for approval to move to Level of Care assessment.
Provide individualized resources to any prospective participant that is not eligible for PACE.
Provide education on criteria to be met that might qualify prospective participant to enroll in PACE. (Ex: disenroll in other state programs, move into a safe and stable home environment, move into an alternate living facility (ALF) or Board and Care facility if 24- hour supervision required.)
Perform an in- home level of care assessment for prospective participants following established guidelines.
Assess participant goals and wishes for participating in PACE program.
Complete DHCS LOC form and Certification form and submit to RN Manager for review and submission to DHCS.
Upon approval to participate in program, determine home health and home care needs in an hour of care format using data and observations from initial home assessment and LOC assessment. The individualized home care determination will be established through the home care service/hour tool and clinical judgement.
Participate in pre-enrollment mini- assessment to review the home care needs assessment with potential participant including family or other support person(s).
Review the participant goals and wishes and determine that they have not changed.
Together with the potential participant and their family or support person(s), establish a home care plan of care. This is to be completed prior to the potential participant signing the enrollment form.
After enrollment, collaborate with home care supervisor to review established home care plan of care to be implemented.
In collaboration with RN manager, audit, and review home care services for compliance to care plan at a minimum of every 3 months. Plan of care should be regularly updated as participant meets goals or require new goals to be established.
In collaboration with RN Manager, review outsourced home care services and home health services to ensure services are being delivered as ordered and discontinued when appropriate on a weekly basis.
Audit home health charts for completion.
Performs other duties as assigned.

Education/Certifications/Licenses/Registrations

California State Board RN License required.
Current American Heart Association healthcare provider CPR (BLS), or Advanced Cardiac Life Support, Advanced Trauma Life Support, or Advance Resuscitation Training.
Graduation from a recognized RN/BSN program.
High School Graduate (or GED equivalent).
Ability and means to travel as needed in a timely manner within San Diego County, to locations that may have limited access to public transportation; proof of liability and property damage insurance on vehicle used is required. DRIVER REQUIREMENTS: Age 21; Licensed for a minimum of 3 years; No violations and/or accidents within 3 years; No vehicle related suspensions/reinstatements; No DUI, reckless or felony Driving within 7 years.

Experience/Specialized skills (including Language)

1 – 2 years of experience working with the older adult population.
Clinical competency with the older adult population including physical and cognitive assessments preferred.
Experience in Home Health Care preferred.
Ability to work effectively in a team environment.
Demonstrated ability to communicate effectively and openly with other interdisciplinary team members on participant status and needs.
Must be able to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high workload environment.
Basic computer literacy to comply with department needs and expectations (i.e., E-HR documentation, obtaining background information and reports, following up on appointments, etc.).
Bilingual English/Spanish preferred.

Physical Requirements/Working Environment

Bending (neck): FREQUENTLY (3 - 6 HRS)

Bending (waist): FREQUENTLY (3 - 6 HRS)

Carrying 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Carrying 11 - 25 lbs: OCCASIONALLY (1 - 3 HRS)

Carrying 25 - 50 lbs: RARELY (0-1 HRS)

Carrying 51 - 75 lbs: NEVER

Carrying 75 lbs: NEVER

Climbing (ladder): NEVER

Climbing (stairs): RARELY (0-1 HRS)

Driving: To drive from one clinic or another, or in the community: REGULAR DRIVING (MORE THAN 3 DAYS PER WEEK)

Exposure to blood borne pathogens and biohazards: YES

Exposure to dust, gas, fumes, or chemicals: Office supplies and equipment.

Fine manipulation: OCCASIONALLY (1 - 3 HRS)

Kneeling: OCCASIONALLY (1 - 3 HRS)

Lifting 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Lifting 11 - 25 lbs: OCCASIONALLY (1 - 3 HRS)

Lifting 25 - 50 lbs: RARELY (0-1 HRS)

Lifting 51 - 75 lbs: NEVER

Lifting over 75 lbs: NEVER

Power Grasping: OCCASIONALLY (1 - 3 HRS)

Pulling 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pulling 11 - 25 lbs: OCCASIONALLY (1 - 3 HRS)

Pulling 25 - 50 lbs: RARELY (0-1 HRS)

Pulling 51 - 75 lbs: NEVER

Pulling over 75 lbs: NEVER

Pushing 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pushing 11 - 25 lbs: OCCASIONALLY (1 - 3 HRS)

Pushing 25 - 50 lbs: RARELY (0-1 HRS)

Pushing 51 - 75 lbs: NEVER

Pushing over 75 lbs: NEVER

Reaching (above shoulder level): FREQUENTLY (3 - 6 HRS)

Reaching (below shoulder level): FREQUENTLY (3 - 6 HRS)

Repetitive use of hand: FREQUENTLY (3 - 6 HRS)

Simple Grasping: FREQUENTLY (3 - 6 HRS)

Sitting: FREQUENTLY (3 - 6 HRS); SITTING ON THE FLOOR

Standing: FREQUENTLY (3 - 6 HRS)

Twisting: FREQUENTLY (3 - 6 HRS)

Use of Personal Protective Equipment: Gloves for patient contact or bodily fluids.

Walking: FREQUENTLY (3 - 6 HRS)

Working around equipment and machinery: Office equipment

Ages of Patients Served: Older Adults

In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits or potential bonuses.

$40.00 - $49.95

If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and/or experience. In addition to these factors – we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth. We also offer a generous compensation and benefits package (more information on our benefits offerings is available here: FHCSD Wellness – Employee Hub (gobenefits.net)

---