Registered Nurse - Clinic; Participant Manager

Registered Nurse - Clinic (Participant Manager)

Join to apply for the Registered Nurse - Clinic (Participant Manager) role at Bienvivir All-Inclusive Senior Health
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Bienvivir All-Inclusive Senior Health (“Bienvivir”) is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly (“PACE”).

PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

• We pay 100% of the MEDICAL monthly premiums for Employee Only coverage.
• We pay 100% of the DENTAL monthly premiums for Employee Only coverage.
• We provide an affordable VISION monthly premium for Employee + Family coverage.
• We pay 100% of BASIC LIFE for a benefit amount of $10,000.
• We offer safe harbor matching contributions for the 403(B) RETIREMENT SAVINGS account.
• We offer up to fifteen (15) days of PAID TIME OFF based on paid hours per pay period.
• We offer eleven (11) company-observed PAID HOLIDAYS.
• We offer education and TUITION REIMBURSEMENT.
• We offer MILEAGE REIMBURSEMENT.

Under the direct supervision of the Clinic Manager, the Participant Manager provides direct participant care. Responsible for the daily coordination of participant care in the following areas: participant-nursing assessments, nursing care plans, health education, maintenance, disease prevention and management of health care both in the clinic and in the participants’ place of residence with appropriate documentation in the medical record.

• Complete initial and routinely required nursing assessments of individual participants to include assessment of medication compliance. Initial assessments will be completed within ten days of participants’ enrollment. Routine reassessments will be completed by participants’ scheduled I/A date.
• Completes participant reassessments and care plans due to changes in participant condition or at the request of the participant/designated representative, as expeditiously as required by their condition.
• Develop the nursing care plan in conjunction with the IDT and PCP and provide documentation that meets the standards mandated by PACE, TDHS and nursing practice.
• Function in the role of triage nurse to include calling participants who do not come to center because they are ill or who miss scheduled clinic appointments and document triage findings.
• Work closely with PCP in the daily management of participant care to include maintaining a continuous flow of participants through the exam rooms, checking on sick participants in the treatment room and assisting with procedures as needed.
• Conduct home visits to include Start of Care assessments, reassessments and to provide skilled care in the participants’ place of residence when participant is not able to attend the center.
• Interact and work with caregivers to coordinate participant care and respond to participant and caregiver phone calls to include providing education and counseling.
• Coordinate hospital, nursing home and assisted living admissions, discharges and transfers.
• Interact and work closely with Interdisciplinary Team to coordinate comprehensive participant care.
• Coordinates with participant, family, caregiver and contacted providers to ensure 24‑hour service delivery.
• Work closely with medical assistants to ensure all scheduled lab work and diagnostic tests are completed and on chart for the next scheduled clinic visit.
• Documents in participants’ medical record as required by departmental policies and procedures.
• Review and coordinate with consult LVNs to ensure all consults and follow up visits are ordered…