RN Case Manager

Petaluma Health Center

• $80K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Active California RN License in good standing
  • Valid California Driver's License
  • Current Basic Life Support (BLS) certification
  • Associate's degree in Nursing; BSN preferred
  • 1+ years of case management experience with high-risk populations preferred
  • Bilingual in English and Spanish preferred, assessed at Advanced or Intermediate level

Responsibilities

  • Oversee transitions of care for high-risk patients from acute settings to home or community resources
  • Collaborate with patients and interdisciplinary teams to create individualized care plans
  • Assess and educate patients on medication adherence and coordinate with pharmacy services
  • Conduct comprehensive phone triage assessments for adult and geriatric patients
  • Maintain accurate documentation of patient interactions and care plans
  • Participate in quality improvement initiatives to reduce hospital readmissions
  • Mentor and train new staff on case management best practices

Benefits

  • 21 Days of Paid Time Off
  • 10 Observed Holidays
  • Reimbursement for RN re-licensure Fee
  • Reimbursement for 20 Continuing Education Units for RN re-licensure
  • Medical Insurance with full deductible coverage
  • 30 Chiropractor and Acupuncture visits per year with health insurance enrollment
  • Dental and Vision Insurance
  • Gym Membership Discounts
  • 401K Matching after 1 year
  • Flexible Spending Account options
  • Life and Long Term Disability Insurance at no cost
  • Employee Assistance Program at no cost
Full Job Description
FULL TIME EMPLOYEE BENEFITS:
  • 21 Days of Paid Time Off
  • 10 Observed Holidays
  • Reimbursement for RN re-licensure Fee
  • Reimbursement of 20 Continuing Education Units for RN re-licensure
  • Medical Insurance (Entire deductible paid by us!)
  • 30 Chiropractor and Acupuncture visits per year included with enrollment in our health insurance plans (Kaiser and WHA)
  • Dental Insurance
  • Vision Insurance
  • Gym Membership Discounts at Synergy Health Club and 24-Hour Fitness!
  • 401K Matching after 1 year of employment
  • Flexible Spending Account, Dependent Care FSA
  • Life Insurance (included at no cost to the employee)
  • Long Term Disability (included at no cost to the employee)
  • Employee Assistance Program (included at no cost to the employee)

Summary: The Case Manager Registered Nurse is responsible for coordinating care for diverse, high-risk, and complex patients transitioning from acute care settings. The Case Manager RN role ensures that clients receive patient-centered care to achieve improved health outcomes, with a particular focus on geriatric patients, vulnerable populations, and those with complex health needs.

Areas of Responsibility:

RN Case Manager Duties:

Patient Care& Education
  • Oversee and facilitate the transition of care for high-risk patients, ensuring continuity and quality from acute settings to home or community resources.
  • Collaborate with patients, families, and interdisciplinary team members to develop individualized care plans for complex and high risk patients.
  • Assess patients' medication regimens, provide education on medication adherence, and coordinate with pharmacy services to ensure safe and effective medication use.
  • Perform medication reviews and adjustments according to protocol, with support of provider
  • Processes medication refills in accordance with established protocols
  • Utilize PHC approved educational materials to provide comprehensive education to patients and their families regarding diagnoses, treatment plans, medications, disease management, self-management techniques, wellness, and related processes, under the direction of licensed clinical staff.
  • Conduct comprehensive phone triage assessments and provide advice for adult and geriatric patients to address concerns, evaluate needs, and implement appropriate interventions under the direction of licensed clinical staff, per PHC triage protocol
  • Work closely with healthcare providers, care transition coordinator, team nurses, behavioral health professionals, and community agencies to enhance care delivery and improve patient outcomes.
  • Participate in quality improvement initiatives aimed at reducing hospital readmissions and improving healthcare outcomes and access to care for high-risk populations.

Documentation & Work Environment
  • Maintain accurate documentation of patient interactions, care plans, and outcomes in compliance with Joint Commission standards and PHC policies
  • Document patient care provided in visit in a timely manner in the electronic medical record
  • Document phone triage assessments appropriately in the electronic medical record
  • Document and reports malfunction of PHC equipment
  • Maintain a clean, orderly and functional work environment
  • Promote continuous improvement of workplace safety and environmental practices

Training:
  • Conduct annual competencies to demonstrate proficiency in patient care and evaluate colleagues to ensure compliance with case management standards.
  • Provide guidance and training to the care transition coordinator and designated staff on case management best practices and processes.
  • Mentor and orient new staff, students and other team members

Education/Experience:
  • Associate of Science in Nursing (ASN/ADN) or sufficient nursing education from an accredited nursing school to obtain a California Registered Nurse (RN) license required
  • Bachelor of Science in Nursing (BSN) preferred
  • At least one year of experience in case management nursing within a healthcare setting focused on high-risk populations preferred

Licenses and Certifications:
  • Active State of California Registered Nurse (RN) License in good standing required
  • Valid State of California Driver' s License (DL) in good standing required
  • Current Basic Life Support (BLS) certificate required
  • Candidate must be able to successfully meet PHC's credentialing and privileging requirements

Language Skills: Bilingual in English and Spanish, both written and verbal preferred. Assessed by language proficiency test as Advanced or Intermediate level.

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