Geriatric Home Health Nurse Case Manager

PACE; Michigan, United States, Northern America, Americas; Hybrid; USD 65,000 - 90,000; Full time

Job summary

PACE seeks a Registered Nurse Case Manager to coordinate nursing care for frail elders in the PACE SEMI program. The role emphasizes autonomy, functional support, and collaboration with a multidisciplinary team in the participant's home.

Responsibilities include assessment, care planning, medication administration, and education for participants and families. Travel within service area is required; CMS competencies and Michigan licensure are mandatory.

Qualifications

• Must be a Registered Nurse with current Michigan licensure; BSN preferred.
• One year of experience with a frail or elderly population.
• Ability to lead licensed and non-professional staff in care delivery.
• Must meet CMS competencies before working independently.
• Must have a valid driver's license and driving record.
• Engages in continuing education and professional development.

Responsibilities

• Assess participants and plan appropriate nursing care at intake and reevaluation.
• Collaborate with participant, family, and multidisciplinary team to develop care plans.
• Encourage autonomy and maximize functional capacity in care delivery.
• Teach, supervise, and counsel participants or caregivers on nursing needs.
• Administer medications as ordered and monitor responses.
• Notify medical personnel of status changes and ensure safe medication use.
• Lead and monitor staff in home nursing care delivery and document outcomes.
• Maintain accurate records and participate in data collection for PACE information.
• Advocate for participants and promote Participant Bill of Rights.
• Possibly provide after-hours on-call medical assistance on a rotating basis.

Skills

RN license

BSN preferred

Adult learning principles

Leadership

Quality Assurance

Data collection

CMS competencies

Education

Bachelor of Science in Nursing

Job description

PACE seeks a Registered Nurse Case Manager to coordinate nursing care for frail elders in the PACE SEMI program. The role emphasizes autonomy, functional support, and collaboration with a multidisciplinary team in the participant's home.

Responsibilities include assessment, care planning, medication administration, and education for participants and families. Travel within service area is required; CMS competencies and Michigan licensure are mandatory.