RN Care Coordinator

UnityPoint Health•Bettendorf, IA

19h

About The Position

The RN Care Coordinator is responsible for coordinating, implementing, and evaluating participant-centered nursing care within the PACE interdisciplinary team (IDT). This role ensures that participants receive comprehensive, high-quality, and cost-effective services across the continuum of care. The RN Care Coordinator performs assessments, creates individualized care plans, oversees clinical interventions, and collaborates closely with physicians, social workers, rehabilitation therapists, home care staff, and other team members.

Requirements

Degree/diploma in nursing
Maintains current registered nursing license in the State of Iowa as required.
Maintains current CPR status
Maintains current Mandatory Reporter
Valid driver’s license when driving any vehicle for work-related reasons.
Valid Auto insurance.

Nice To Haves

Two years clinical nursing experience preferred in hospital or nursing facility setting

Responsibilities

Participant Assessment & Care Planning Conduct initial, semi-annual, and change-of-condition nursing assessments for PACE participants.
Participate actively in IDT meetings to develop, revise, and implement individualized care plans.
Identify participant needs related to chronic disease management, medication management, safety, ADLs/IADLs, mental health, and caregiver support.
Care Coordination Coordinate services across clinic, home care, specialty care, hospital, and long-term care settings.
Communicate regularly with participants, families, caregivers, and providers to ensure seamless transitions of care.
Track changes in condition and ensure timely follow-up evaluations and interventions.
Clinical Care & Oversight Provide direct nursing services including skilled nursing visits, triage, wound care, and medication administration as needed.
Monitor participant response to treatment and adjust care plans in collaboration with the IDT.
Ensure appropriate communication of critical findings and abnormal results.
Interdisciplinary Team Collaboration Serve as the nursing point-of-contact for assigned participants.
Collaborate with physicians, social workers, therapists, dietitians, and home care staff to ensure comprehensive, coordinated care.
Participate in daily team huddles and scheduled IDT care review meetings.
Documentation & Compliance Document all assessments, care coordination activities, and clinical interventions in the electronic health record promptly and accurately.
Adhere to PACE regulatory requirements, organizational policies, and evidence-based clinical standards.
Assist in quality assurance/performance improvement (QAPI) activities