Job Description

About Midland Care Connection


Midland Care Connection is a mission-driven, not-for-profit organization dedicated to improving quality of life for older adults in the community. Our PACE program serves older adults at risk for nursing?home placement so they may remain in their homes and communities with dignity and independence. As a Clinical Liaison in our PACE program, you'll play a key role in bridging the clinical care team, participants, families, and referral sources.


Position Summary


The Clinical Liaison will serve as the primary clinical outreach and coordination resource for the PACE program. This role combines clinical knowledge, assessment skills, relationship-building with referral sources (hospitals, clinics, SNFs, community agencies), and participant/family engagement to promote successful enrollment, continuity of care, and high?quality outcomes. The Clinical Liaison will collaborate with the interdisciplinary PACE team to ensure participants' needs are met, goals are aligned, and transitions into or within the program are as seamless as possible.


Key Responsibilities


Engage potential participants, families, and referral/partner organizations (e.g., hospitals, physicians, senior living communities, home health) to educate about the PACE model and Midland Care's services.


Conduct clinical assessments or screenings as needed to determine eligibility, care needs, and risk factors in coordination with the intake/admissions team and clinical staff.


Facilitate care transitions (e.g., hospital discharge, SNF to home, home health to PACE) to ensure continuity, follow-up, and coordination with the PACE clinical team.


Serve as a liaison between clinical staff (physicians, nurses, therapists), case managers, and participants/families to communicate participant condition, service needs, goals of care, and changes in status.


Maintain and build relationships with referral sources and community partners: schedule meetings, attend networking/education events, provide program updates, and act as a resource for partner organizations seeking to refer eligible individuals.


Participate in interdisciplinary team meetings, care planning conferences, and assist in documentation and communication of care plan goals and participant progress.


Monitor and follow up on participant outcomes post?admission (or during enrollment) to identify unmet needs, gaps in services, and collaborate with the care team to adjust the plan accordingly.


Identify and report trends or barriers to enrollment/retention of participants, and collaborate with leadership to develop strategies for improvement.


Maintain accurate documentation of outreach, referrals, assessments, and follow?up activities in the program's electronic system and ensure compliance with regulatory, quality, and organizational standards.


Required:


Bachelor's degree in Nursing, Social Work, Healthcare Administration, or related field.


Strong clinical background (e.g., RN, LPN with care coordination experience, or social work with medical/geriatrics setting) with at least 1-2 years of experience working with older adults, frail populations, or in transitional care. (Midland has similar roles requiring one year of experience with frail population.) app.hellotriad.com+1


Excellent interpersonal, communication (verbal and written), presentation, and relationship?building skills.


Ability to travel within service region for outreach, meetings, and participant visits; valid driver's license and reliable transportation required.


Self?motivated, organized, capable of managing multiple priorities, and working autonomously while collaborating with a team.


Familiarity with the PACE model (preferred) and understanding of care transitions, senior health issues, home- and community-based services.


Proficient with electronic health records, Microsoft Office (Word, Excel, Outlook), and comfortable learning new systems.


Preferred:


Previous experience in PACE, home health, hospice, or geriatrics.


Existing network of referral sources in the Kansas City / northeast Kansas region.


Master's degree or advanced certification in case management or geriatric care.


Core Competencies


Participant-centered advocacy: ability to represent the participant's voice, respect dignity, engage families and caregivers.


Clinical coordination: translate clinical findings into actionable care plans and referral pathways.


Relationship management: build trust and durable partnerships with internal and external stakeholders.


Communication & education: explain complex care models and options to lay persons, families, and professional partners.


Initiative & problem?solving: identify system gaps or barriers and work proactively toward solutions.


Data & documentation: track outreach metrics, referral conversion, participant outcomes, and maintain accurate records.


Work Environment & Physical Requirements


Office setting combined with field/outreach work (visits to hospitals, senior living, participant homes).


Occasional lifting, assisting participants during home visits, movement between facilities.


Regular travel within service territory; some evening or off-hour community events may be required.


Fully aligned with Midland Care Connection's commitment to mission, dignity, and independent living for older adults.


Benefits


Comprehensive health, dental, vision insurance.


403(b) retirement plan with employer match.


Paid time off (PTO), personal days, "Taking Care of You" days, paid holidays.


On?site education center for professional development and continuing education.


Inclusive, supportive work culture aligned with mission of supporting older adults.


How to Apply


To apply, please submit your resume and cover letter through our careers page!