Come join our awesome team as an Inegrated Care Manager with Senior Community Care of Colorado. Senior Community Care of Colorado PACE is part of Volunteers of America National Services which serves as the Housing and Healthcare subsidiary of the Volunteers of America parent organization. Pay: $83,000 - $91,000 annually Schedule: Fulltime, M-F, 8a-5p and participation in on call rotation which may include 1 weeknight per week and weekend call rotation. The Integrated Care Manager will provide comprehensive medical case management of PACE participants in Montrose and Delta Counties, by partnering with the various entities (hospital, physicians, IDT) in order to manage medical care and treatments aligning with the participant's pathway and PACE philosophy, reducing need for institutionalizations. Follow all PACE Participants who are admitted to ER, hospital, or acute rehab and act as liaison between care team and facility to ensure timely and safe discharged. Act as liaison between care team and residential care facilities to ensure participant care plans are developed collaboratively to meet participant needs. Employer/Employee Benefits: * Medical, Dental and Vision insurance * Health Savings Account (HSA) * Flexible Saving Account (FSA) * 403(b) - with discretionary contribution * Paid Vacation/Sick Time * Employee Referral Program Benefits with minimal to no cost to employees: * Scholarships * Employee Assistance Program (EAP) * Wellness program * Life insurance (with an option to purchase additional) * Short term disability * Loan program * NEW! NetSpend option: 50% of wages before payday * Ministry Program QUALIFICATIONS: * Education: Registered Nursing * Experience: Five (5) years nursing experience with three years' experience in a geriatric health setting including a minimum of two years of demonstrated successful supervisory experience. * Have a minimum of one year of experience in working with the frail or elderly * Must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact. * Must have a valid driver's license and have means of transportation within one hundred (100) miles or more daily. * Must clear background check. * Must have experience communication and working collaboratively with physicians and medical providers. * Skills and Knowledge: * Knowledge of principles, practice standards and techniques of a Registered Nurse (RN). * Working knowledge of PACE regulations and Colorado * Working knowledge of healthcare and aging * Working knowledge of physical, mental, spiritual, and social needs of the frail elderly and their families. * Working knowledge of quality improvement and cost containment * Demonstrate effective leadership and decision-making * Demonstrate strong facilitation and conflict resolution * Ability to foster and build professional relationships among staff and community Medical * Ability to effectively and efficiently, plan prioritize and follow-up on/delegate responsibilities. * Effective written and oral communication * Working knowledge of local health care and geriatric service networks. ESSENTIAL FUNCTIONS: * Follow participants with acute hospital admissions by daily/as needed visits, coordinating with hospital medical providers and collaborating with discharge planners for discharge service needs. * Follow participants post-acute and ER discharge, coordinating care with Care Team/IDT. * Follow participants in skilled/rehab setting to ensure treatment goals are being attained and to support effective discharge planning in coordination with PACE Care Team. * Follow participants in long term care to act as liaison between PACE Care Team and residential care facility and to bridge collaboration in development and execution of participant care plan across all care settings. * Involved with coordination of care of participants with the following: * Transplant consideration * Oncology * Complicated medical conditions * Attends medical appointments as needed for participants with * Dementia * Complicated medical conditions * Surgical procedures being considered * Directly involved in communicating with participants and families about Advance Directives, in particular participant change of status with medical decline, and End of Life consideration. * May assist in completing RN post hospital visits, RN assessments and other RN duties as assigned. * Attends and participates in Care Team Meetings/IDT to ensure team is kept up to date with all relevant participant needs. * Collaborates with Medical Director and PACE Nurse Practitioners as required to ensure participant care needs are met across all care settings, particularly in ER, hospital, rehab, acute care and long-term care settings. * Participates in on-call nursing rotation as scheduled. * Is primarily responsible for the oversight of the SCC Infection Control