Nursing Professional in Enrollment Operations

2 weeks ago

Victorville, California, United States HIGH DESERT PACE Full time
Benefits:
  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance
Position Overview
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, coordinating closely with physicians, social workers, and other team members.
  • Physical presence at various locations is essential for executing job responsibilities effectively.
  • Collaborate with the Business Development and Enrollment Development Departments to evaluate if prospective participants meet the necessary guidelines for Nursing Level of Care.
  • Schedule and conduct home visits or clinic appointments to perform assessments for eligibility.
  • Conduct initial nursing evaluations, including functional assessments and home safety evaluations, to determine eligibility for the High Desert PACE Program.
  • Prepare and submit documentation from home visits to expedite the review process for potential participants.
  • Oversee the annual State level-of-care review process.
  • Work alongside the interdisciplinary team and outreach & enrollment team.
  • Ensure the confidentiality and privacy 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.
  • Engage with the California Department of Health Care Services for eligibility determinations.
  • Manage audits of participant medical records conducted by the PACE Nurse Assessor.
  • Conduct semi-annual level of care redeterminations for all participants.
  • Support business development initiatives and participate in outreach programs.
  • Coordinate appointments for prospects requiring further assessments by interdisciplinary team members.
  • Participate in case management and provide consultation on medical and nursing issues.
Qualifications
  • Associate degree from an accredited nursing program is required.
  • Current Registered Nurse License in the applicable state.
  • 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 elderly or frail populations.
Skills & Competencies
  • Understanding of the physical, mental, and social needs of older adults.
  • Proficient in physical assessment and chronic disease management for elderly patients.
  • Strong communication skills, both verbal and written.
  • Ability to work effectively within an interdisciplinary team environment.
  • Proficient in computer usage.
  • Adept at managing shifting priorities based on participant needs.
  • Excellent organizational skills.
  • Demonstrates the necessary skills and knowledge as outlined in the position-specific Competency Assessment Profile.
Working Conditions
The working conditions and physical demands described here 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 and to members' homes is required.
  • A valid driver's license and proof of automobile insurance coverage are necessary.
  • May require the use of a personal cell phone for business purposes.

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