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Registered Nurse for Enrollment Services
2 months ago
- 401(k) Plan
- Dental Coverage
- Health Insurance
- Paid Time Off
- Vision Coverage
Position Summary
The Enrollment Registered Nurse operates under the general guidance of the Marketing, Enrollment, and Network Director. This role collaborates with Business Development and Enrollment Representatives to assess the eligibility of potential participants for the High Desert PACE Program.
Key Responsibilities
- Act as a vital member of the outreach and enrollment team, working in conjunction with physicians, social workers, and other team members.
- Physical presence at the High Desert PACE facility and/or participant homes is crucial for fulfilling job responsibilities.
- Coordinate with the Business Development and Enrollment Development Department to evaluate if prospective PACE participants satisfy Title 22 Guidelines for Nursing Level of Care.
- Schedule and perform home visits and/or clinic appointments to conduct level of care assessments for eligibility determination.
- Execute initial nursing evaluations, including nursing assessments, functional evaluations, and home safety checks in the homes of potential High Desert PACE participants.
- Timely documentation of home visit findings, submission to the California State Level-of-Care (LOC) nurse for review, and addressing inquiries to facilitate the review process.
- Oversee the annual State level-of-care review process.
- Collaborate with the interdisciplinary team (IDT) and outreach & enrollment (O&E) team.
- Ensure the confidentiality and privacy of all company protocols and information regarding 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.
- Work closely with the California Department of Health Care Services (DHCS) PACE Nurse Assessor to make eligibility determinations for prospective new PACE participants.
- 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 to be submitted to the DHCS PACE Nurse Assessor.
- Support and engage in business development initiatives and participant census growth as part of the Business Development Department.
- Participate in outreach programs.
- Coordinate with the Interdisciplinary Team (IDT) and arrange appointments for prospects needing further assessments by other IDT members.
- Engage in case management peer reviews of client records and provide consultation to case managers and staff regarding medical and nursing matters.
Education & Qualifications
- Associate degree from an accredited nursing institution is required.
- Current Registered Nurse License in the state of employment.
- Current CPR certification or the ability to obtain it.
- A minimum of 3 years of healthcare experience, particularly in geriatrics.
- At least 1 year of experience working with the elderly or frail population.
Skills & Competencies
- 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.
- Demonstrated ability to function effectively within an interdisciplinary team.
- Proficient in computer usage.
- Able to adapt to changing priorities based on participant needs.
- Excellent organizational skills.
- Exhibits necessary skills and knowledge as outlined in the position-specific Competency Assessment Profile.
Working Environment
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.
- Ability to work 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).
