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Registered Nurse (RN) - Eligibility

Location : Sacramento
Job Type : Direct
Reference Code : Sacramento
Required Years of Experience : 3
Required Education : Associates Degree
Job Industry : Healthcare - Health Services

Job Description :

 


The Eligibility Registered Nurse - RN works together with the Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the PACE Program.



•Works closely with the Business Development and Enrollment Development Department to determine if prospective participants. 
•Schedules and conducts home visits and/or center-based clinic appointments, to make level of care assessments to determine eligibility.
•Completes eligibility referral document, in close collaboration with the Organization’s Primary Care Physician, and compiling supporting documentation for application to the State for enrollment.
•Works closely with the California Department of Health Care Services (DHCS), In-Home Operations (IHO) Level of Care nursing staff to make eligibility decisions about prospective new PACE participants.
•Managing semi-annual audits of participant’s medical records conducted by the DHCS and IHO Nursing staff.
•Completes semi-annual level of care redetermination for all participants to be submitted to the DHCS IHO.
•Supports business development and census growth process by being part of the Business Development Department. Participates and assists with outreach programs.
•Serve as member of the Interdisciplinary Team (IDT), and coordinate appointments for prospects that require further assessments by other IDT members.
•Participates in the case management of peer review of client records and provides consultation to case managers and other staff members regarding medical and nursing issues.
•Maintain knowledge and expertise in eligibility, enrollment, and program specifications for the Federal and State health coverage programs Medicare and Medi-Cal, and specifically as those guidelines apply to the Program of All Inclusive Care for the Elderly (PACE).



Required Qualifications :

REQUIRED

Education
•Associates degree from accredited nursing school

Licensure, Certification, Registration or Designation
•Current Registered Nurses License in state in which working required
•Current CPR certification or the ability to obtain CPR certification is required.

Work Experience and Qualifications
•Three (3) years of health care experience with emphasis in geriatrics
•A minimum of one (1) year working with the frail or elderly is required

PREFERRED

Education
•Bachelor’s degree in nursing

Licensure, Certification, Registration or Designation
•Certification as a Gerontological Nurse

Work Experience and Qualifications
•Prior experience working with State and Federal Regulators a plus


Physical Demands /Work Environment



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