Demo

Interdisciplinary Coordinator

PACE
Milford, DE Full Time
POSTED ON 12/15/2025
AVAILABLE BEFORE 2/5/2026

Job Summary:

The PACE Your LIFE Interdisciplinary Team (IDT) Coordinator facilitates care planning and coordination activities for the PACE Your LIFE IDT. The IDT Coordinator ensures that the IDT completes assessments, care plans, documentation, and service delivery in compliance with Federal and State regulations governing PACE. The IDT Coordinator ensures that the IDT maintains appropriate and high-quality care and service delivery to participants. The IDT Coordinator provides support to the IDT as deemed necessary to ensure effective and efficient care management. The IDT Coordinator is the liaison between the IDT and Enrollment regarding potential PACE enrollees.

Essential Duties and Responsibilities:

o Ensures that all PACE required assessment and reassessments are completed by the IDT members prior to care planning meetings.

o Facilitates morning meetings, pre-enrollment discussions, and care plan meetings.

o Coordinates with the IDT to ensure that the specific needs of the participant are appropriately addressed.

o Communicates effectively with participants, families, IDT members, and other PACE team members to ensure participant’s care needs are addressed.

o Manages information to measure and provide direction to the IDT for continual improvement in documentation and service delivery. Creates and maintains logs of caseloads for reporting and to monitor effectiveness of interventions by the IDT.

o Creates and maintains logs for assessments, reassessments, eligibility, grievances, disenrollment's, and service delivery.

o Provides support to IDT in the coordination of 24-hour care delivery.

o Encourages effective relationships among IDT members geared to team building and maintenance of a cohesive team.

o Conducts audits of participants’ medical records to ensure compliance with PACE policies and procedures.

o Participates in program and policy development regarding IDT procedures and processes.

o Facilitates and monitors enrollment and disenrollment from PACE Your Life.

o Demonstrates active participation in QI processes.

o Oversees the data entry of IDT members to ensure that accurate and timely health care data and adequately documents participants’ issues.

o Maintains up-to-date participants’ records including care plans, authorizations provided or denied by the IDT, progress notes and discharge summaries. Follow-up with Center Director when performance issues are identified by the IDT members with regarding to IDT responsibilities related to care provision, care coordination, documentation issues, and care management.

o Contributes to the agency’s goal and objectives in maintaining a high-quality medical delivery system through the principles of quality improvement.

o Collaborates with the Director of Quality and Compliance to ensure compliance by the IDT to PACE regulations and policies.

o Serves as the Electronic Medical Record (EMR) subject matter expert, offering guidance, troubleshooting, and training to IDT members to ensure effective and compliant system use.

o Every effort has been made to identify the essential functions of this positions; however, this in no way states or implies that these are the only duties you will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is an essential job function of this position.

Qualifications:


  • Education:

  • B.S. in Social Work, Human Services, Psychology, Health Care Administration, preferred, but not required.

  • Experience:

    • Minimum of 2 years’ experience working in heath care.

    • Experience working with frail or elderly populations is required.

  • Specialized Skills & Training:

    • Strong interpersonal and communication skills, with the ability to navigate disagreements and team dynamics.

    • Strong analytical thinking and problem-solving abilities.

    • Clear, professional written and verbal communication skills.

    • Ability to effectively manage time and handle multiple responsibilities.

    • Proficient in record-keeping and documentation.

  • Additional Requirements:

    • Must pass background checks as required by regulatory standards.

    • Must be free from illegal use of drugs and alcohol.

    • Must maintain confidentiality of participant records and sensitive information.

    • Ability to work in a dynamic and collaborative environment.

Salary.com Estimation for Interdisciplinary Coordinator in Milford, DE
$49,230 to $60,540
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