RN-CASE MANAGER
3 weeks ago
It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do - in the health of our patients, our loved ones, and our community.
Benefits Eligible
Full-Time Benefit Eligible
Work Shift
Day (United States of America)
Department
8519 CalAim Enhanced Care Mgmt
The RN Case Manager assesses plans, coordinates care, evaluates and advocates for services to meet patients health needs as they move through the continuum of care to promote quality and cost effective outcomes.
QUALIFICATIONS
License /Certification
Required:
California RN license
BLS
Education
Preferred: BSN, MSN, or currently enrolled in RN-BSN program
Experience
Required: Two years of acute care clinical nursing experience (LVN/RN) with at least one year as a RN
JOB RESPONSIBILITIES
Essential
Identifies needs and facilitates provision of services with physicians, nurse managers and multidisciplinary team members as the patient moves through the continuum of care.
Assessment
Acts as a resource person for clinical care issues, identifies action plans, and facilitates communication with appropriate physician(s) for direction.
Assists and communicates with physician offices and all appropriate departments to discuss new admissions, demographic information, and other data pertinent to the patient/family which may affect their care.
Evaluates the assessment process of new patients within 30 days of admission to determine needs and develop a Care Management Plan to address Social Determinants of Health (SDOH) barriers.
Planning
Establishes a specific plan with action steps for each patient within assigned population.
Collaborates with the patient/family, care team, and physician(s) to determine goals and objectives to achieve patient/family outcomes, which include physical and psychological factors.
Takes the lead in assessing care plan progression and revising care plan as necessary.
Rounds with physicians and multidisciplinary team.
Coordinates with the multidisciplinary team to ensure graduation planning goals and objectives are developed and modified as needed.
Implementation
Takes the lead in moving patients through the continuum of care in a timely, cost effective, and safe manner.
Assists in the organization and integration of resources needed to meet stated goals and plans. Works with patient, family, multidisciplinary team, and outside services to accomplish set outcomes.
Supervises implementation of treatment plan, including appropriate use of pre-printed orders.
Documents in patient Progress Notes information including significant patient data, problems identified, assessment needs, and treatment goals. Documents findings in the electronic health record.
Makes timely referrals for services.
Evaluation
Evaluates care plan for appropriateness and monitors progress towards outcomes. Suggests appropriate level of care when changes in level of function, medical, and psychological issues arise.
Reviews medical records of patients for proper and timely documentation of services provided, evidence of functional progress.
In collaboration with patient, family, and multidisciplinary team, changes the plan of care as appropriate.
The nurse's practice is guided by the Code for Nurses.
Decisions and actions on behalf of patients/residents are determined in an ethical manner.
Maintains patient confidentiality within legal and regulatory parameters. Acts as a patient/resident advocate and assists patients/residents in developing skills so they can advocate for themselves.
Delivers care in a nonjudgmental and nondiscriminatory manner that preserves patient autonomy, dignity and rights.
Additional
Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area. Knowledgeable of growth and development for all patient/family cultural, linguistic, spiritual, gender, and age specific needs. Able to effectively communicate and care for patient and family as reflected in the Plan for Provision of Care.
Performs other duties as assigned.
Pay Range
$46.44 -$69.66
If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.
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