RN Care Manager

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. Registered Nurse Care Manager Summary: The RN Care Manager is responsible for assessing the care needs of participants, providing nursing and healthcare interventions, and evaluating outcomes of care on an ongoing basis. In collaboration with the interdisciplinary team (IDT), develops plans of care to meet participants’ needs and delegates tasks to clinic, center, and home‑care aides according to participant needs and care plans. Essential Duties and Responsibilities: 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 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, providing coordination and direct care as indicated to promote continued care in the community or optimal institutional care. 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, notifying 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 a backup 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. Perform other duties as required or requested. Experience, Education and Certifications: Bachelor of Science in Nursing Degree preferred. State RN License required (NJ: Licensed by the New Jersey State Board of Nursing). BLS required within 90 days of employment. 1 year of experience working with a frail or elderly population preferred; training will be provided upon hiring if applicable. Experience in home care, long‑term care and/or managed care preferred. 1 year experience providing care as an RN required. Pre‑Employment Requirements: Must have reliable transportation, a valid driver’s license, and the minimum state‑required liability auto insurance. Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact. Pass a comprehensive criminal background check that may include federal and state Medicare/Medicaid exclusion lists, criminal history, education verification, license verification, reference check, and drug screen. Required immunizations. Benefits: Generous PTO 401K with Match* Life Insurance Tuition Reimbursement Flexible Spending Account Employee Assistance Program BoldAge PACE provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. *Match begins after one year of employment #J-18808-Ljbffr