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Registered Nurse for Enrollment Services
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 in conjunction with physicians, social workers, and other team members.
- Conduct in-person visits at the High Desert PACE facility and/or participant residences to fulfill job responsibilities.
- Collaborate closely with the Business Development and Enrollment Development Department to evaluate if prospective participants meet the Title 22 Guidelines for Nursing Level of Care.
- Schedule and perform home visits and/or center-based clinic appointments to assess eligibility through level of care evaluations.
- Execute initial nursing assessments, including nursing evaluations, functional assessments, and home safety evaluations, to determine PACE eligibility for prospective participants.
- Prepare documentation from home visits promptly and submit it to the CA State Level-of-Care (LOC) nurse for review, addressing any inquiries to expedite the process.
- Monitor and manage the annual State level-of-care review process.
- Work collaboratively with the interdisciplinary team (IDT) and outreach & enrollment (O&E) team.
- Uphold the privacy and confidentiality of all company procedures and information related to team members, participants, and their families.
- Complete eligibility referral documents in close partnership with the Organization's Primary Care Physician, compiling necessary documentation for State enrollment applications.
- Liaise with the California Department of Health Care Services (DHCS) PACE Nurse Assessor to make eligibility determinations for new participants.
- Oversee semi-annual audits of participant medical records conducted by the DHCS PACE Nurse Assessor.
- Conduct semi-annual level of care redeterminations for all participants to be submitted to the DHCS PACE Nurse Assessor.
- Contribute to business development and census growth initiatives as part of the Business Development Department.
- Engage in outreach programs to promote enrollment.
- Collaborate with the Interdisciplinary Team (IDT) to coordinate further assessments for prospects requiring additional evaluations.
- Participate in case management peer reviews of client records and provide consultation on medical and nursing matters to case managers and staff.
- Associate degree from an accredited nursing program is required.
- Valid Registered Nurse License in the state of employment.
- Current CPR certification or the ability to obtain it.
- Minimum of 3 years of healthcare experience, particularly in geriatrics.
- At least 1 year of experience working with frail or elderly populations.
- 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.
- Proven ability to work effectively within an interdisciplinary team environment.
- Competent in computer usage.
- 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 described are representative of those that must be met by 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 at specified minimum amounts is necessary for mileage reimbursement.
- May require the use of a personal cell phone for business purposes (potential stipend eligibility).
