RN Case Manager; Utilization Review

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California.

• California RN license (required)
• BLS (required)
• BSN, MSN, or currently enrolled in an RN‑BSN program (preferred)
• Two years of acute care clinical nursing experience (LVN/RN) with at least one year as an RN (required)
• Department‑specific requirement for Emergency Department: three years of RN experience in an Emergency Department or Critical Care setting (required)

• Identifies needs and facilitates the 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 physicians 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 patient/family, care team, and physician(s) to determine goals and objectives; takes the lead in assessing care plan progression and revising it 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 the 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 toward 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.
• Adheres to the Code for Nurses and 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 non‑judgmental and nondiscriminatory manner preserving patient autonomy, dignity and rights.

• Post Acute Care Case Manager: reviews and screens 100% of patients referred to TCS using Inter Qual Criteria; interviews, researches, and gathers data to identify patient needs and formulate a post‑acute plan of care in collaboration with the patient, family, physician, acute case manager, and other disciplines; facilitates transition more efficiently to TCS by ensuring proper documentation, orders, and arrangements are complete for timely transfer.
• Program Liaison for Inpatient Rehabilitation: assumes responsibility for the implementation of each individual patient program; assists the patient/family to become adequately oriented to their program; enables the patient’s program to proceed in an orderly, purposeful, and goal‑directed manner; promotes participation of the person served on an ongoing basis; participates consistently in team conferences…