Clinical Nurse Specialist

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 con