Responsibilities:
The Eligibility RN works together with the Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the InnovAge PACE Program.
Physical attendance at an InnovAge facility and/or an InnovAge participant home is essential to performing the job duties.
Works closely with the Business Development and Enrollment Development Department to determine if prospective PACE participants meet Title 20 Guidelines for Nursing Level of Care, required for all PACE 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
Associates degree from accredited nursing school required
Current Registered Nurses License in state in which working
Current CPR certification or the ability to obtain CPR certification
3+ years health care experience with emphasis in geriatrics
1+ year working with the frail or elderly
PREFERRED
Certification as a Gerontological Nurse
Prior experience working with State and Federal Regulators
Bi-lingual
Benefits:
InnovAge’s Program of All-inclusive Care for the Elderly (PACE) is an alternative to nursing facilities.
Seniors receive customized healthcare and social support at a nearby PACE center supported by a team of medical experts dedicated to providing personalized healthcare and support to help them age at home.
Our greatest assets are our team members who make a difference in the lives of those we serve every day.
Elevate your future with co-workers passionate about a patient-centered care model supported by comprehensive services to improve the quality of care while reducing over-utilization of high-cost care settings.
As an equal opportunity/affirmative action employer InnovAge is committed to and values an inclusive and diverse workplace.
All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender, gender identity/expression, national origin, disability or protected veteran status, pregnancy or any other status prohibited by applicable law.
Salary ranges are dependent on a variety of factors, including qualifications, experience, and geographic location.
Range is not inclusive of potential bonus or benefits.
Comprehensive benefits include m/d/v, short and long-term disability, life insurance and add, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company paid holidays.
Posted Salary Range: USD $49.
00 - USD $54.
00 /Hr.
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