RN - PACE Program-Naples

Job Overview

Role: RN, Case Manager. The RN, Case Manager 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 keep the participant in their home environment as long as possible.

Day‑1 mileage reimbursement, Monday‑Friday schedule, $10,000 sign‑on bonus with a 2‑year commitment.

• Current RN license in the state where the employee will be working.
• Minimum of one year nursing experience; hospice or hospital experience preferred.
• Certification of completion of Alzheimer’s Disease and Related Dementias Training through the Florida Department of Elder Affairs (for employees working at PACE).
• Previous experience using an EMR/EHR system.
• Valid driver’s license and automobile insurance per company policy.
• Reliable transportation to meet the visit schedule.
• Ability to use equipment with visual and auditory mechanisms.
• Effective verbal and written communication in English.
• Ability to visit participants in their homes for assessments.
• Physical ability to lift patients and/or equipment, bend, push/pull, kneel and perform other essential functions with or without reasonable accommodation.
• Active Basic Life Support certification for healthcare professionals from the American Heart Association or the Red Cross.

• Provide reassurance on the phone, assist in finding solutions to patient/family questions, coordinate in‑person visits when needed.
• Utilize appropriate support or expert resources to resolve complex or difficult situations.
• Document patient/family contact information in the EMR and communicate with the IDT.
• Complete initial and semi‑annual assessments for all company services.
• Explain services to patients/families, address questions about patient needs and fears, present services compassionately.
• Provide information to physicians and other IDT members and initiate the Plan of Care.
• Initiate skilled nursing interventions to enhance prevention, prevent complications, alleviate symptoms and maximize physical and emotional comfort.
• Obtain physician orders and complete documentation per company policy.
• Act as the company representative at assigned facilities, facilitate referrals, and work closely with hospitals, physicians, and the public.
• Communicate frequently with IDT members and provide all necessary clinical communication in a timely manner using SBAR.
• Discuss any potential needs with after‑hours staff.
• Develop strong relationships with case managers, physicians, and other staff at facilities.
• Provide and manage direct care to patients and families as part of the IDT, incorporating psychosocial, spiritual, cultural, physical, and biological components.
• Coordinate the Plan of Care, ensuring it reflects evolving patient needs.
• Educate patients, families, caregivers, and other health professionals about disease processes, prevention, palliative interventions, caregiving, dying processes, and safety practices.
• Conduct home visits to assess home safety, medication compliance, nutrition, and durable medical equipment compliance.
• Report changes in patient condition to appropriate IDT members or other health professionals.
• Participate with the IDT to evaluate hospice referrals or admissions for care appropriateness.
• Attend daily IDT collaboration meetings.
• Present concise and pertinent oral and written reports to the IDT.
• Communicate accurately and completely with physicians, staff, patients, families, and supervisors, using positive approaches.
• Supervise patient care provided by community health workers and home health aides as requested.
• During emergencies, report to a designated location to ensure continuity of services, possibly before the scheduled time or overnight.
• Perform other duties as assigned.

Must see, hear, talk, walk, use hands to finger, handle or feel. Frequently required to stand, sit, reach with hands or arms, lift, bend, and balance. Occasionally required to pull, push, stoop or crouch, kneel, and climb stairs.

Pay range: $60,058.27 – $90,087.92 per year.

Position requires consent to drug and/or alcohol testing after a conditional offer of employment and ongoing compliance with the Drug‑Free Workplace Policy. All employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse for eligibility verification after a conditional offer of employment and ongoing eligibility. For more information, visit