RN Care Coordinator

Role The RN, Care Coordinator is responsible for assessing and identifying patient/family needs, utilizing the nursing process, coordinating the Plan of Care with the Interdisciplinary Team (IDT), and providing clinical, palliative and supportive care to the patient/family unit in order to keep the participant in their home environment as long as possible. Qualifications Current license as RN in the state where the employee will be working Minimum of one (1) year nursing experience; hospice or hospital experience preferred Employees working at PACE, certification of completion of Alzheimer’s Disease and Related Dementias Training through the Florida Department of Elder Affairs Previous experience working with an EMR/EHR system Valid driver’s license and automobile insurance per Company policy (Mobile Driver) Reliable transportation to meet visit schedule Ability to use equipment with visual and auditory mechanisms Effective communication in English (verbal and written) Ability to visit participants in their homes for assessments Ability to perform essential functions and physical requirements (e.g., lifting patients, bending, pushing/pulling, kneeling) with or without reasonable accommodation Active BLS certification for healthcare professionals from the American Heart Association or Red Cross Competencies Satisfactorily complete competency requirements for this position. Responsibilities Of All Employees Represent the Company professionally through care delivered and services provided. Comply with all state, federal and local regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company’s health, safety and security practices. Maintain confidentiality of patients and sensitive information. Use resources fiscally responsibly. Promote the Company via community and professional organizations. Participate proactively in performance improvement. Improve own professional knowledge and skills. Advance electronic media skills. Support Company research and educational activities. Share expertise with co‑workers formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate. Job Responsibilities Provides and manages direct care to patients and families as part of the IDT, incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow‑up. Coordinates the Plan of Care, ensuring an individualized plan reflects the patient’s evolving needs. Educates patient, family, caregivers and other health professionals about disease process, decline, prevention, palliative interventions, caregiving, dying process and safety practices. Participant visit frequency depends on risk score/needs. Home visits to assess home safety, medication compliance, nutritional compliance, DME compliance and overall ability to live safely in the community. Reports changes in patient condition to appropriate IDT members or other health professionals. Participates with IDT to evaluate hospice referrals/admissions for level of care appropriateness. Attends daily IDT collaboration meetings. Presents concise oral and written reports to IDT; respects and encourages input from all disciplines. Communicates accurately and completely to physicians, staff, patients, families and supervisors using positive approaches. Supervises patient care provided by Community Health Workers and Home Health Aides as requested. During emergencies (e.g., hurricanes) the RN, Case Manager may be required to report to a company‑designated location to ensure continuity of services, including early reporting or overnight stays if needed. Performs other duties as assigned. Physical Demands The following abilities are required: see, hear, talk, walk, use hands to finger, handle or feel. Frequently required: stand, sit, reach with hands/arms, lift, bend, balance. Occasionally required: pull, push, stoop/crouch, kneel, climb stairs. Compensation Pay Range $61,860.66 – $96,657.28 Drug and Alcohol Testing This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as ongoing compliance with the Drug‑Free Workplace Policy. Background Screening Information All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit #J-18808-Ljbffr