Description:
Who We Are
Are you interested in working for an organization whose mission is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?
Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the “aging in place” industry and we have had the honor of serving Fresno, Bakersfield and Orange County seniors and their families/caregivers.
Job Summary
The Clinical Nurse Specialist will be responsible for appropriate coordination of care upon discharge from contracted hospitals and nursing facilities. They will also support clinical quality improvement activities. This includes chart auditing electronic health records, assisting in quality of care investigations and identifying clinical root cause analysis. The Clinical Nurse Specialist may also provide support to process complex authorizations.
Essential Job Function
Duties include, but are not limited to:
- Actively monitors admissions and discharges from hospital and nursing home facilities using Epic, Manifest Medex, and
other electronic health records systems.
- Elicits medical information from external facilities and medical records within 24-48 hours of discharge and provides timely
reports and authorizations for recommended treatment upon Interdisciplinary Team (IDT) determination.
- Research and coordinates referrals to appropriate agencies/facilities, specialty providers, and ancillary services, utilizing in-
network and out-of-network resources.
- Recommends and coordinates interventions to facilitate high-quality, cost-effective care, monitoring treatment, progress,
and outcomes of patients.
- Supports the Quality Improvement Department in conducting potential quality of care reviews and root cause analysis.
- Documents and maintains patient-specific utilization management records in electronic health records systems and files.
- Collaborate with the Director of Nursing and Primary Care Clinic and the Chief Medical Officer on case reviews for pre-
service, concurrent, post-service and retrospective claims medical review.
- Reviews Part B verses Part D medications.
- Receives incoming calls from providers, professionally handles complex calls, research to identify timely and accurate
resolution steps.
- Communicate with weekend and after-hours on-call staff, following up on issues as necessary.
- May provide coverage for Registered Nurse Case Manager. This includes completing assessments, participating in IDT
meetings, and other case management duties for assigned coverage panel.
- Attend and participate in staff meetings, in-services, projects, and committees as assigned.
- Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
- Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
- Be flexible in the schedule of hours worked.
- May be required to use personal vehicle, if applicable. If using a personal vehicle, a valid California Driver’s License is
required.
Requirements:
Knowledge, Skills, and Abilities
- Working knowledge of physical, mental, and social needs of the frail elderly and their families.
- Effective case management skills.
- Ability to work with ethnically diverse populations.
- Ability to apply creative problem-solving skills to complex issues.
- Ability to work with interdisciplinary teams.
- Strong organizational skills, flexible, resourceful, and energetic.
- Effective oral and written communication skills.
Working Conditions and Physical Demands
The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ability to access all areas of the center throughout the workday.
- Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm
movements, occasional bending, reaching forward and overhead; squatting and kneeling.
- Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance
from another qualified employee when attempting to lift or transfer objects over 50 pounds.
- Ability to communicate verbally, with an excellent comprehension of the English language.
- Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.
- Be flexible in the schedule of hours worked.
- Work location may include clinical, hospital, nursing facility, and participant home as needed.
Education and Certification
- Active Registered Nurse license to practice in California.
- CPR with First-Aid certification
- Demonstrate the ability to act independently using sound clinical judgement
- Valid California Driver’s license
Experience
- Minimum of one (1) year of documented experience working with a frail or elderly
- Minimum of two (2) years of managed care experience is strongly preferred.
- Minimum of two (2) years of prior experience in nursing, healthcare or other related fields.
- Experience performing utilization management, quality improvement or case management activities at a medical group,
health plan or a management services organization is a plus.
- Experience with Managed Medi-Cal and Medicare is preferred.
- Is medically cleared from communicable diseases and has all immunizations up-to-date before engaging in direct participant
contact
Core Values
- Respect is at the core of our interactions.
- Honesty and Integrity with every endeavor
- Patient – Centered care aligned with participant values, beliefs, and preferences.
- Encouragement that motivates and empowers others to be the best they can be.
- Quality Care that is efficient, transformative, and innovative.