RN, Navigator, Care Transitions (Per Diem, Day Shift)

About Us

Adventist Health Hanford, located in a tight-knit community in Kings County, has been serving the Central Valley since 1965. We are comprised of a 173-bed hospital and many outpatient clinics offering primary and specialty care services. Hanford residents enjoy the city's historic charm and family-friendly atmosphere, with Yosemite, Sequoia, and Kings Canyon National Parks within an hour's travel time.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven by the mission of living God's love by inspiring health, wholeness, and hope.

About the Role

Acts as a patient advocate, guiding patients through the clinical care system. Establishes contact with new patients and/or family members or caregivers, understanding clinical care options and directing patients to healthcare services within the organization, at outside facilities, and within the community for timely treatment and recovery. Identifies and addresses population and patient-specific barriers to care that might prevent timely and appropriate treatment. Coordinates the continuum of care for patients post-hospitalization, working closely with case managers, discharge planners, and home health staff to monitor recovery of high-risk patients and coordinate follow-up care.

Responsibilities

• Assists patient and family in identifying and accessing appropriate institutional and community resources.
• Implements appropriate care intervention and follow-up to ensure patients receive timely care, preventing delays and ensuring access to appropriate services and follow-up instructions from managing physicians.
• Interacts with other hospital departments to fulfill patient needs.
• Makes initial and ongoing assessments of patient needs (clinical, emotional, and social) and makes appropriate recommendations or referrals for care.
• Facilitates the timely completion and confidential reporting of diagnostic testing results to patients, families, and ordering clinicians through active tracking of ordered tests.
• Collaborates with the team of patient, family, and healthcare providers in providing patient care in a safe, healing, humane, and caring environment.
• Provides learning opportunities for patients, family members, and team members, including direct health information to patients, families, and treatment teams.
• Documents coordinator and patient interactions in electronic or hardcopy charts in a manner consistent with hospital standards.
• Creates reports from patient data such as volumes and outcomes.
• Monitors, analyzes, and reports clinical and operational key indicators to the clinic governing body, identifying opportunities for performance improvement.
• Identifies both index and readmission patients who are high-risk for readmissions and may require additional interventions and education.
• Helps monitor the recovery of high-risk patients, coordinating follow-up care, including follow-up phone calls post-hospitalization, assisting with scheduling primary or specialty care visits, and facilitating home health services.
• Performs other job-related duties as assigned.

Requirements

• Bachelor's Degree in Nursing (BSN): Preferred
• Case management experience in a healthcare setting: Preferred
• Experience in acute, emergency, or perinatal setting: Preferred
• Registered Nurse (RN) licensure in the state of practice: Required
• Cardiopulmonary Resuscitation (CPR) certification or Basic Life Support (BLS) certification from an approved vendor per AH policy: Required

Pay

The estimated base pay for this position is $54.20 to $74.34 per hour. Additional individual compensation may be available through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions.

Schedule

This is a per diem position with a shift length of 12 hours.