PACE KC RN Care Manager

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This Registered Nurse position has the primary responsibility to participate as a member of the interdisciplinary team to assess, plan, implement and evaluate care provided in the patient/participants place of residence. This nurse will actively participate in coordination of all aspects of patient’s care, in accordance with current professional standards and practice. PACE KC/Swope Health 24/7 nursing coverage rotation. This position is supervised as designated on the agency organizational chart.

• Maintains clinical competencies.
• Provides patient/caregiver education and training specific to identified needs.
• Collaborates in the provision of care, treatment and services with the interdisciplinary team to meet patients’ needs and maintain continuity of care between disciplines, programs, services and with other organizations as needed.
• Participates in agency activities to include interdisciplinary team meetings, staff meetings, and other committee meetings as assigned and educational opportunities.
• Collaborates with the physician(s) and acts as liaison for the care coordination of the designated case load.
• Assesses patient needs and provides services within scope of practice and based on individualized plan of care appropriate to the patient’s needs, strengths, limitations and goals.
• Communicates/collaborates with contracting providers regarding services provided.
• Evaluates care, treatment and services to include active participation in interdisciplinary team meetings.
• Assesses for discharge and/or transfer needs and facilitates the process to ensure that continuity of care, treatment and service is maintained.
• Follows policies and procedures in the assessment, planning, intervention, evaluation and documentation of patient and family care.
• Performs clinical duties within the nursing scope of practice.
• Documents in electronic records within stated standards and provides complete and accurate supporting documentation.
• Participates in the agency performance improvement program.
• Participates in surveillance, prevention and control of infection.
• Participates in environmental safety and equipment management procedures.
• Utilizes information management to support decision making to improve patient outcomes, improve health care documentation, assure patient safety and improve performance in patient care, treatment and services.
• Completes annual mandatory education requirements.
• Develops partnerships within the community and educates community members and healthcare providers about Midland Care services.
• Provides education related to hospice to staff in alternate care settings (nursing homes, hospitals, assisted‑living facilities, etc.).
• Utilizes company resources in a prudent and appropriate manner.
• Manages patient care within accepted standards for utilization of DME, medications and supplies.
• Follows agency procedures/standards for productivity, attendance, use of PTO and approval of overtime.
• Reviews and evaluates requests for approval from accounts payable for patient specific requests.
• Upholds PACE KC/Swope Health mission and values; communicates philosophy; supports patient and family care when needed; maintains confidentiality and respects autonomy.
• Provides good customer service, participates in performance improvement, and collaborates with staff.
• Maintains a professional appearance and is reliable and punctual.
• Understands relevant computer systems and software.
• Accepts duties cooperatively and performs all assignments effectively while following organizational policies and procedures.

• Current unrestricted State of Missouri License to practice as a Registered Nurse.
• One‑year professional medical‑surgical experience.
• Availability of reliable transportation is required.
• Knowledge of professional nursing theory, standards of nursing practice, scope of practice and relevant statutes and regulations.
• Ability to prioritize work, meet deadlines, handle multiple projects, pay strong diligence and accuracy and work under pressure in a cooperative work…