RN | Registered Nurse Navigator | PACE Program

Midland Care Connection, Inc.; Topeka (KS); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance options

Dental, vision, and prescription plans

403(b) retirement plan match

Paid time off

Job summary

Midland Care Connection is seeking an RN Nurse Navigator to coordinate PACE participant care across settings, guiding transitions and collaborating with external providers to ensure seamless, high-quality care. The RN will advocate for participants and support after-hours nursing calls as needed.

The role requires an unrestricted RN license, experience in case management or geriatrics, and strong communication within an interdisciplinary team. Travel to participant sites is expected.

Qualifications

• Current, unrestricted RN license in the applicable state.
• Graduate of an accredited school of nursing.
• Minimum two years of clinical nursing experience in case management, care coordination, geriatrics, home health, hospice, or related setting.
• Knowledge of care coordination, discharge planning, and transitions of care.
• Excellent communication and collaboration within an inter-disciplinary team.
• Proficiency with EHR and standard computer applications.
• Ability to travel to participant care settings as needed.
• Participation in PACE nursing call rotation may be required.

Responsibilities

• Coordinate all aspects of care across healthcare settings for PACE participants.
• Guide participants through transitions and coordinate with external providers.
• Promote positive health outcomes and exceptional participant experience.
• Participate in after-hours PACE nursing call rotation as needed.

Skills

RN license

Care coordination

Discharge planning

Transitions of care

Strong communication

EHR proficiency

Team collaboration

Transportation/travel

Education

RN degree

BSN (preferred)

Tools

EHR systems

Standard computer apps

Job description

Midland Care Connection

Midland Care Connection is a not-for-profit, community-based organization dedicated to helping older adults and seriously ill individuals stay independent and supported in their homes. Established in 1978, we offer a full continuum of care, including hospice, palliative care, home health, grief and loss counseling, and our signature PACE (Program of All-Inclusive Care for the Elderly) program. Our mission centers on "meeting individual needs through innovative care solutions," and we serve people across multiple counties in northeast Kansas.

PACE Program

The PACE (Program of All-Inclusive Care for the Elderly) program is designed to help older adults remain safely in their homes rather than entering nursing facilities. It provides complete medical care, rehabilitation, medications, transportation, social services, and supportive therapies and coordinated by an interdisciplinary care team. Participants receive personalized care plans tailored to their unique needs, along with access to a PACE center for social activities, meals, and clinical services. By integrating medical and supportive care under one program, PACE helps seniors maintain independence, improve quality of life, and continue living in their communities with dignity.

RN Nurse Navigator

The PACE RN Nurse Navigator serves as a key member of the interdisciplinary care team, ensuring seamless coordination and continuity of care for PACE participants receiving services outside of Midland Care facilities. This role is responsible for guiding participants through transitions across healthcare settings, collaborating with external providers, and coordinating all aspects of care to promote positive health outcomes and an exceptional participant experience. Working in accordance with professional nursing standards, the Nurse Navigator advocates for participants, facilitates communication among care teams, and responds flexibly to changing participant needs across the continuum of care. The position also supports after-hours participant care by participating in the PACE nursing call rotation as needed.

Qualifications

Required

• Current, unrestricted Registered Nurse (RN) license in the applicable state
• Graduate of an accredited school of nursing
• Minimum of two (2) years of clinical nursing experience, preferably in case management, care coordination, geriatrics, home health, hospice, or a related setting
• Knowledge of care coordination, discharge planning, and transitions of care
• Strong assessment, critical thinking, and clinical decision-making skills
• Excellent communication and interpersonal skills with the ability to collaborate effectively within an interdisciplinary team and with external healthcare providers
• Proficiency with electronic health records (EHR) and standard computer applications
• Ability to organize, prioritize, and manage multiple participants and competing responsibilities
• Valid driver's license, reliable transportation, and ability to travel to participant care settings as needed
• Ability to participate in the PACE nursing call rotation

Preferred

• Bachelor's degree in Nursing (BSN)
• Previous experience in a PACE program or with the care of older adults with complex medical, functional, and psychosocial needs
• Certification in Case Management (CCM), Gerontological Nursing (RN-BC), or a related specialty
• Experience coordinating care across multiple healthcare settings, including hospitals, skilled nursing facilities, specialty clinics, and home health
• Knowledge of Medicare, Medicaid, and PACE regulations
• Bilingual or multilingual communication skills
• Experience with quality improvement initiatives and population health management

What’s in it for you?

• Health insurance options for employees and dependents
• Dental, vision, and prescription drug plans
• Flexible Savings Accounts (FSA) or Health Savings Accounts (HSA), with employer contributions
• Paid Time Off (PTO), Personal and Taking Care of You Days
• Holiday pay (six holidays per year)
• 403(b) ERISA Retirement Plan, match provided
• Free group life and AD&D insurance of $20,000
• On-site education center to provide professional development and CEU credits
• Free Employee Assistance Program (EAP) for employees and dependents
• Paid monthly volunteer time at non-profit organizations
• Uniform Allowance Program

Midland Care Connection is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.