Eligibility Assessment Nurse
2 months ago
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Under the general guidance of the Marketing, Enrollment, and Network Director, the Eligibility Registered Nurse collaborates with Business Development and Enrollment Representatives to assess the eligibility of potential participants for the High Desert PACE Program.
Key Responsibilities
- Serve as a vital member of the outreach and enrollment team, working closely with physicians, social workers, and other team members.
- Physical presence at the High Desert PACE facility and/or participant homes is essential for fulfilling job responsibilities.
- Collaborate with the Business Development and Enrollment Development Departments to evaluate if prospective participants meet Title 22 Guidelines for Nursing Level of Care.
- Schedule and conduct home visits and/or center-based clinic appointments to perform level of care assessments.
- Conduct initial nursing evaluations, including nursing assessments, functional assessments, and home safety evaluations to determine PACE eligibility.
- Prepare documentation from home visits promptly and submit to the California State Level-of-Care nurse for review.
- Oversee the annual State level-of-care review process.
- Work in conjunction with the interdisciplinary team (IDT) and outreach & enrollment (O&E) team.
- Ensure the privacy and confidentiality of all company procedures and participant information.
- Complete eligibility referral documents in collaboration with the Organization's Primary Care Physician and compile necessary documentation for State enrollment applications.
- Liaise with the California Department of Health Care Services (DHCS) PACE Nurse Assessor to make eligibility determinations.
- Manage semi-annual audits of participant medical records conducted by the DHCS PACE Nurse Assessor.
- Conduct semi-annual level of care redeterminations for all participants for submission to the DHCS PACE Nurse Assessor.
- Support business development initiatives and participate in outreach programs.
- Collaborate with the Interdisciplinary Team (IDT) to coordinate appointments for prospects requiring further assessments.
- Engage in case management peer reviews and provide consultation on medical and nursing issues.
- Associate degree from an accredited nursing program is required.
- Current Registered Nurse License in the relevant state.
- Current CPR certification or ability to obtain certification.
- Minimum of 3 years of healthcare experience, particularly in geriatrics.
- At least 1 year of experience working with the elderly or frail population.
- Understanding of the physical, mental, and social needs of frail older adults.
- Proficient in physical assessment and chronic disease management for older adults.
- Strong listening, oral, and written communication skills.
- Ability to work effectively within an interdisciplinary team environment.
- Proficient in computer applications.
- Capable of managing shifting priorities based on participant needs.
- Excellent organizational skills.
- Demonstrates required skills and knowledge as outlined in the position-specific Competency Assessment Profile.
The working conditions and physical demands outlined here are representative of those necessary for an employee to successfully perform the essential functions of this role.
Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
- Must be able to adhere to the required schedule.
- Physical strength is necessary to perform essential job functions.
- Occasional travel between various sites, nursing/group homes, and participant residences is required.
- Use of a personal vehicle is necessary.
- A valid driver's license is required.
- Proof of automobile insurance coverage is necessary for mileage reimbursement.
- May require the use of a personal cell phone for business purposes (potential stipend eligibility).
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