PACE Enrollment Registered Nurse

Registered Nurse (RN) Enrollment

Community health is about more than just vaccines and checkups. It's about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We're with you every step of the way, with the care you need for each of life's chapters. At Neighborhood, we are Better Together.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

The Registered Nurse (RN) Enrollment works to support the mission and vision of Neighborhood Healthcare (NHC) by providing outreach and enrollment services to patients for Neighborhood Healthcare's Program for All-Inclusive Care for the Elderly (PACE). This role will follow leads for prospective PACE enrollees to complete assessments to determine eligibility into the program. In addition, this role will play a critical part in initiating the coordination of care for newly enrolled patients.

This is a hybrid position that requires fieldwork conducting in-home assessments for PACE applicants. This position will cover our entire service area (Riverside County and South San Bernardino County).

Schedule:

Monday-Friday, 8am-5pm.

Responsibilities

• Responds to individual inquiries regarding PACE, including phone calls, web site inquiries, walk-ins, home visits, hospital, and nursing home visits
• Provides tours of PACE centers to interested family members, potential participants, community partners, and providers
• Reviews the enrollment process with potential enrollees, families, and referring parties
• Provides detailed medical history and lifestyle assessments to applicants enrolling in PACE in-home and the PACE center
• Provides referrals to other programs for individuals not appropriate for PACE and for those who choose not to enroll
• Serves as the liaison for California Department of Health Care Services (DHCS) level of care (LOC) assessments
• Assesses and documents patient statuses to support the regulatory reviews and approvals of initial enrollments (LOC for PACE)
• Organizes and submits reporting information to DHCS, such first submission, resubmission, or deferral status for applicants or prospective enrollees
• Coordinates with the intake team if additional applicant information is required
• Monitors the statuses of DHCS submissions and coordinates with enrollment team
• Conducts full medical and environmental in-home assessments on prospective enrollees
• Coordinates with home care team when reassessments are required for applicants
• Performs patient assessments to identify and address overt problems/needs; including priority setting, referrals and follow-ups, diagnostics review, medical record interpretation, and data collection to complete required forms for compliance
• Participates on the Interdisciplinary Team (IDT) to provide information for enrollment decisions and ongoing communication with referral sources, potential enrollees, and families during the intake process
• Creates initial care plans with participant during care planning stage with IDT
• Completes appropriate documentation related to participant assessments as required
• Prepares and oversees the semi-annual level of care on-site audits in coordination with other IDT members
• Observes and reports changes in participants physical, mental, emotional, and social functioning to the IDT
• Keeps informed of PACE eligibility requirements, general Medicaid eligibility guidelines, and supplemental insurance issues as they affect enrollment and the Medicare CMS regulation for PACE
• Conducts clinical presentations, as required
• Provides responsive and high-quality services to patients,…