RN Case Manager - TRU - PACE - Clinic
About The Position
The Clinic RN Case Manager plays a vital role in coordinating patient care and services in collaboration with the interdisciplinary team (IDT) and contracted providers. This position delivers skilled nursing care to program participants, ensuring the highest quality outcomes in alignment with PACE policies and regulatory standards. This role includes triaging and assessing participants, implementing physician and nurse practitioner orders, developing individualized care plans, and providing education to participants and their caregivers. The RN Case Manager serves as a central communication point, keeping the care team informed of participant conditions and needs.
Requirements
- Associate Degree in Nursing (ADN) required; BSN preferred.
- Active Registered Nurse (RN) license in good standing.
- Current BLS/CPR certification (or ability to obtain within 60 days of hire).
- 2–3 years of experience as a Registered Nurse required.
- Familiarity with Electronic Medical Records (EMR) systems.
- Strong clinical assessment and critical thinking skills.
- Excellent communication and collaboration abilities.
- Ability to manage multiple priorities in a fast-paced environment.
- Strong organizational and documentation skills.
- Commitment to compassionate, participant-centered care.
Nice To Haves
- Experience working with frail or elderly populations preferred.
- Experience supporting individuals with mental health conditions preferred.
- Experience working within an Interdisciplinary Team (IDT) model preferred.
- Experience in care coordination or case management strongly preferred.
Responsibilities
- Coordinate participant care proactively with the interdisciplinary team to optimize outcomes.
- Perform initial and annual participant assessments to identify needs and ensure appropriate services.
- Develop, implement, and manage individualized care plans.
- Provide skilled nursing care, including administering medications and treatments in accordance with standards.
- Implement physician and nurse practitioner orders accurately and in a timely manner.
- Manage and maintain accurate participant medical records in accordance with PACE standards.
- Assist with hospital, rehabilitation, and long-term care admissions and transitions.
- Actively participate in all IDT meetings, communicating participant status and contributing to care planning.
- Collaborate with internal teams and external contracted providers (e.g., nursing homes, labs, medical equipment vendors).
- Maintain effective communication with leadership and escalate concerns as appropriate.
- Participate in the PACE Quality Assurance and Performance Improvement (QAPI) program.
- Identify opportunities for process and quality improvements and contribute to initiatives.
- Ensure compliance with PACE policies, OSHA guidelines, and infection control practices.
- Maintain participant confidentiality and uphold HIPAA standards.
- Manage a participant panel and ensure timely, high-quality care delivery.
- Balance multiple priorities and work independently with minimal supervision.
- Participate in the on-call rotation and ensure appropriate follow-up on after-hours concerns.
- Maintain professional certifications and affiliations.
Benefits
- Paid Vacation time
- 401(k) with match
- Health, dental, vision & life insurance
- FSA & HSA available
- Paid orientation
- Paid training
- PSLF Eligible Employer
- Referral & signing bonuses (if applicable)
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
