Job Title
RN, Case Manager (CNA), Per Diem, Days at Adventist Health
Location
Templeton, California
Job Summary
The RN Case Manager is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s resources and right to self‑determination. The role ensures that care is provided at the appropriate level based on medical necessity, and evaluates patients for transition needs to promote timely throughput, safe discharge, and prevention of avoidable readmissions. It integrates national standards for case‑management scope of services, including utilization management, transition management, care coordination, compliance with regulatory requirements, and education to physicians, patients, families, and caregivers.
Key Responsibilities
Accurate medical necessity screening and submission for Physician Advisor review.
Care coordination, transition planning assessment, and reassessment.
Implementation or oversight of transition plan.
Leading and facilitating multidisciplinary patient care conferences.
Managing concurrent disputes.
Making appropriate referrals to other departments.
Identifying and referring complex patients to Social Work Services.
Communicating with patients and families about the plan of care.
Collaborating with physicians, office staff, and ancillary departments.
Leading and facilitating Complex Case Review.
Ensuring patient education is completed to support post‑acute needs.
Timely completion of concise documentation in the Case Management system.
Maintenance of accurate patient demographic and insurance information.
Identification and documentation of potentially avoidable days.
Identification and reporting of over‑ and under‑utilization.
Other duties as assigned.
Job Requirements
Graduate of a school of nursing: Required.
Two years acute care RN experience: Required.
Experience in utilization review, discharge planning and/or home health: Preferred.
Recent experience in acute care hospital case management: Preferred.
Licenses / Certifications
Current RN license in state of practice: Required.
Accredited Case Manager (ACM): Preferred.
Registered Nurse (RN) license in state of practice: Required.
Essential Functions
Assists physicians in making admission decisions considering observation, outpatient, inpatient status and payer guidelines.
Demonstrates clear and effective communication with nursing and physicians.
Works cooperatively with nursing, dietary, PT and social services to develop a safe discharge plan.
Maintains patient, co‑worker, and hospital privacy.
Obtains psycho/social assessment according to discharge planning protocol for all age groups.
Reviews medical history, physical examination, and assessment data to develop discharge plan.
Initiates contact with patient and/or family during discharge planning.
Coordinates team or family conferences on complex patients.
Ensures patient is medically stable for discharge.
Maintains a reference network of health systems and community resources.
Performs other job‑related duties as assigned.
Organizational Requirements
Adventist Health is committed to the safety and wellbeing of all associates and patients. All associates must receive required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
E-Verify Participation
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.