RN Care Manager - Exempt

Why work with us

• People-first environment: what is important to those we serve is important to us
• Make an impact: enhance the quality of life for seniors
• Professional growth: access to training and career development

About the role

BoldAge PACE is an all-inclusive program of care, personalized to meet the individual health and well-being needs of our participants. Our approach is simple: we listen to our participants and their caregivers to truly understand their needs and desires.

Responsibilities

• Assess the care needs of participants, provide nursing and healthcare interventions, and evaluate outcomes on an ongoing basis
• In collaboration with the interdisciplinary team (IDT), develop plans of care to meet participants’ needs
• Delegate tasks to clinic, center, and homecare aides according to participant needs and care plans
• Collaborate and communicate with the primary care provider, clinic staff, and other members of the IDT
• Provide care to participants in the clinic, center, and participant homes as needed
• Provide high-quality clinical care and serve as a member of the PACE interdisciplinary team (IDT)
• Provide nursing care in the center, clinic, contracted facilities, and participants’ homes according to each participant’s plan of care
• Participate in the 24/7 “on-call” process for triage of participants and their needs
• Assess, plan, and coordinate participants’ home care services and provide input to the IDT in developing home care plan interventions
• Monitor participants’ acute and chronic care needs in all settings
• Provide coordination and direct care as indicated to promote continued care in the community or optimal institutional care as needed
• Ensure timely follow-up by providers on specialist visits and assist with obtaining specialist reports, facility documentation, and labs if needed
• Reconcile facility MARs for your assigned panel of participants monthly to ensure accuracy and medication adherence; notify provider of any discrepancies
• Notify participants of normal test results
• Complete timely and accurate nursing assessments in accordance with policies and regulatory requirements
• Implement nursing-related care plan interventions
• Teach participants, caregivers and families about self-care, medications, healthy lifestyles, infection control and safety to promote optimal health and safety
• Review and revise goals and approaches to participants’ care in coordination with participant, family, caregiver and interdisciplinary team
• Work collaboratively with the interdisciplinary team (IDT) to develop and implement comprehensive plans of care for participants
• Develop and maintain positive relationships and communication with co-workers, participants and their families/significant others, and members of the community
• Participate in all interdisciplinary team meetings
• Assist the interdisciplinary team members in understanding the significant nursing, self-care and functional needs related to the participant’s health problems
• Support OT as back-up to performing the duties of Home Care Coordinator on the IDT as needed/when assigned
• May perform the duties of other IDT members based on professional licensing, competencies, and experience as needed
• Actively participate in utilization review meetings and quality improvement projects/meetings
• Evaluate the competence of CNAs and Home Care Aides and delegate tasks and duties to them as indicated
• Participate in family meetings, staff meetings, in-service and training and orientation programs as required
• Follow all PACE Program Policies and Procedures and Occupational Safety and Health Administration (OSHA) safety guidelines
• Protect privacy and maintain confidentiality of all company procedures and information about employees, participants and families
• Practice standard precautions and follow PACE Program Infection Control protocols

Qualifications

• Bachelor of Science in Nursing degree preferred
• State RN license required
• BLS required (have within 90 days of employment)
• 1 year of experience working with a frail or elderly population preferred; if not present, training will be provided upon hiring
• Experience in home care, long-term care and/or managed care preferred
• 1 year experience providing care as an RN required

Pre-employment requirements

• Reliable transportation, a valid driver’s license, and the minimum state-required liability auto insurance
• Medically cleared for communicable diseases with all immunizations up to date before engaging in direct participant contact
• Pass a comprehensive criminal background check that may include, but is not limited to, federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen