Job ID: 290116588  |  Last Updated: 9/23/2022

RN (PACE) Intake

Orange, CA
Applicant Contact
Jeffrey Lum
HR Manager (Recruitment)
(657) 900-1160
Accepts J-1 Visas

Job Description

RN (PACE) Intake

Job Description

Why CalOptima?
CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto "Better. Together. is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. If you're looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.

Job Summary

Under the direct supervision of the Manager of Marketing and Enrollment, the Registered Nurse (RN) for Intake and Outreach is responsible for completing, tracking and submitting the Level of Care tool (LOC) to Department Health Care Services (DHCS) to determine eligibility of potential participant and follow up with appropriate action upon DHCS determination. The incumbent works very closely with the Enrollment Team to pre-screen potential participants and to provide additional community-based resources for potential participants who are not eligible or interested in program. Additionally, the incumbent also participates in Community Outreach to raise awareness and promote the Program All-Inclusive Care Elderly (PACE) program. The incumbent will facilitate program presentations in the community and provide program tours to other healthcare providers.

Position Responsibilities:

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Screens potential participants in the home (and or virtually via pre-approved telehealth platforms) and assess their environment, personal care needs of the frail, and elderly population, and identifies skilled nursing needs based on DHCS eligibility guidelines.
Gathers prospective participant data and information during home visit assessment with the use of an interpreter as needed.
Completes LOC tool including diagnoses, medications, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) in addition to a narrative summarizing potential participant's skilled nursing needs.
Submits completed LOC to DHCS.
Tracks responses from DHCS and coordinates with Enrollment team.
Presents approved participant to Interdisciplinary Team (IDT) and shares additional findings.
Coordinates with Enrollment team to bring potential participants into PACE for assessments if potential participants are deferred by DHCS.
Tracks whether assessments have been completed and re-submits to DHCS for response.
Prepares enrollment performance metrics reports and be able to adjust strategies as necessary based on data analysis.
Assists Enrollment Coordinators with program presentations and tours to the community.
Drives to participants' homes as needed.

Annual Level of Care Re-Certifications

Obtains the monthly program participant re-certification list.
Reviews medical records for each participant, on-going services and services received within past year using EMR, plan of care for the upcoming year using EMR, and IDT annual assessments to ensure continuing skilled nursing needs are identified.
Determines current medical status and functional capabilities for each participant.
If assessment is missing or incomplete, notifies discipline responsible to complete it within a specified timeframe.
If assessments are complete, writes an annual LOC tool based on that information.
Scans completed LOC and send to appropriate discipline for EMR entry in a timely manner.
Ensures the LOC recertification's are completed in a timely manner as per DHCS protocol.

LOC Audit

Receives notification from DHCS of upcoming audit including date on site and list of program participants who will be audited for reassessments.
Provides list of program participants for a specified period to DHCS.
Collaborates with Health Plan Associate to gather hard copies of participant's program information.
Coordinates with CalOptima Compliance Department to ensure requested documentation is complete.
Assists as needed when DHCS auditor is on site.
Follows up with DHCS on findings and assist with correction action plan as needed.
For annual re-certifications that have been waived from further reassessments, track on spreadsheet and give to Health Plan Associate.

Completes other projects and duties as assigned.

Possesses the Ability To:

Work independently and as an effective member of a team and with geriatric participants.
Establish and maintain effective working relationships with CalOptima Health's leadership and staff.
Use effective time management and project planning skills.
Communicate clearly and concisely, both orally and in writing.
Provide exceptional customer service and maintain accurate records.
Be self-motivated and a team player with the ability to take initiative.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

High School diploma or equivalent required.
Current and unrestricted RN license in good standing to practice in the State of California.
1 year of nursing experience with Home or Community Health Provider experience with relevant experience within the last 3 years required.
1 year of experience working with the frail or elderly population required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
Valid driver's license and vehicle, or other approved means of transportation, an acceptable driving record, and current auto insurance will be required for work away from the primary office 50% of the time or more.

Preferred Qualifications:

Bachelor's degree in Nursing or other related field, and/or relevant experience in Health Care preferred.
Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

Knowledge of:

Nursing best practices.
Medi-Cal, Medicare, and community engagement a plus.
Culture and needs of the socially and ethnically diverse populations that CalOptima Health serves.
Available community resources.

Department(s): PACE (Program All-Inclusive Care Elderly)
Reports to: Manager, Marketing and Enrollment (PACE)
FLSA status: Non-Exempt
Salary Grade: M - $40.87 - $63.99 ($85,000 - $133,100)

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

Job Location: Orange, California

Position Type:

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