Under the direct supervision of the Manager of Marketing and Enrollment, the RN for Intake and Outreach is responsible for completing, tracking, and submitting the Level of Care tool (LOC) to DHCS (Department Health Care Services) to determine eligibility of potential participant and follow up with appropriate action upon DHCS determination. This position also 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. This position also participates in Community Outreach to raise awareness and promote the PACE program. The incumbent will also facilitate presentations in the community and providing tours to other healthcare providers.
POSITION RESPONSIBILITIES:
- Screens potential participants in the home (and or virtually) and assess their environment, personal care needs of the frail, and elderly population, and identify skilled needs based on DHCS eligibility guidelines.
- Gathers data and information during home visit assessment with the use of an interpreter as needed.
- Completes LOC tool including diagnoses, medications, ADL’s (Activities of Daily Living), IADL’s (Instrumental Activities of Daily Living) in addition to a narrative summarizing potential participant’s skilled needs.
- Submits completed LOC to DHCS.
- Tracks responses from DHCS and coordinating with Enrollment team.
- Presents approved participant to IDT (Interdisciplinary Team) and sharing additional findings.
- Coordinates with Enrollment Team to bring potential participants into PACE for assessments if potential participants are deferred.
- Tracks whether assessments have been completed and re-submit to DHCS for response.
- Assists Enrollment Coordinators with program presentations to the community.
- Other projects and duties as assigned.
LEVEL OF CARE RE-CERTIFICATIONS
- Obtains the monthly 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 needs are identified
- Determines current medical status and functional capabilities for each participant.
- If assessment is missing or incomplete, notify discipline responsible to complete it within a specified timeframe.
- If assessments are complete, write 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 enrollees who will be audited for reassessments.
- Provides list of new enrollees for prior six months to DHCS.
- Collaborates with Health Plan Associate to gather hard copies of enrollees.
- 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.
Required Skills
- Work independently and as an effective member of a team and with geriatric participants.
- Drive to participants’ homes on as needed.
- Conduct telehealth home visits as needed by means of a virtual platform.
- Develop rapport, establish, and maintain effective relationships with internal and external contacts at all levels and from varying cultural and ethnic backgrounds.
- Use effective time management and project planning skills.
- Communicate clearly and concisely, both verbally 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.
Required Experience
EXPERIENCE & EDUCATION:
- High School diploma or equivalent required.
- Bachelor’s degree in Nursing or other related field, and/or relevant experience in Health Care preferred.
- Current RN license in good standing to practice in the State of California.
- 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.
- 1 year nursing experience with Home or Community Health Provider experience with relevant experience within the last 3 years required.
- 1 year experience working with the frail or elderly population required.
- Bilingual in English and in one of CalOptima's defined threshold language is preferred.
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 serves.
- Available community resources.
Grade N: $71,760 - $114,712
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