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#0220-RH1104-AC
Supplemental Questionnaire

Last Name
First Name
1

PATTERN I

Do you possess at least two years of full-time paid RN acute care experience equivalent to a San Joaquin County Staff Nurse III?

Please note:  Acute care is a level of care where patients are treated for a brief acute episode of illness, for conditions that are the results of a disease or trauma, and during recovery from surgery. Acute care is generally only provided in hospitals where all of the following medical units/services are provided:

  • Emergency
  • Medical Surgical
  • Labor and Delivery
  • Intensive Care Unit
Yes No
1a

If yes, describe your clinical journey-level Staff Nurse duties and responsibilities.  Include your employer (hospital) where you obtained this experience. 

2

PATTERN II

Do you possess a Bachelor's degree in Nursing, Health Sciences, or closely related field?  (If yes, please make sure this is clearly identified in your application or resume)

Yes No
2a

Do you possess at least one year of full-time paid RN acute care experience equivalent to a San Joaquin County Staff Nurse III?

Yes No
2b

If yes, describe your clinical journey level Staff Nurse duties and responsibilities. Include your employer (hospital) where you obtained this experience.

3

Do you possess a current valid California Registered Nurse license? 

Yes No
3a

Please provide your RN license number.

4

Do you possess paid RN case management work experience?

Yes No
4a

If yes, please describe your RN case management work experience in detail and include the popluation of patients for whom you provided care (MediCal, Medicare, Commerical eligible or uninsured patients), identify your title, employer, and the hours worked per week. Please include in your answer if your case management experience is from an acute care hospital.

5

Do you possess experience with case management/utilization management software systems?

Yes No
5a

If yes, please identify the software systems for which you possess experience utilizing.

6

Do you possess current state, national, or other certification in case management? (If yes, email certification to  kparker@sjgh.org or fax to 209-468-6271).

Yes No
7

Please identify your interest in Staff Nurse IV Inpatient Part-time premium and Per diem employment opportunities in the Case Management Department:

Check all that apply below:

Yes, I am interested in part-time premium employment
Yes, I am interested in per diem employment