Ambulatory Care Manager (RN) - Alex Park

Rochester Regional Health • Full-time • Rochester, New York 14607, United States • $65,000 - $95,000 / year • 3m ago

HOW WE CARE FOR YOU

At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

No Weekends or Holidays
Personal Time that includes Vacation Time, Sick Time & Holidays
Health & Wellness Benefits starting Your First Day
Medical, Dental & Vision Programs tailored to Your Needs
Student Loan Repayment Program
Free ASN to BSN Program through Advance U
Tuition Assistance & Reimbursement Program
Clinical Ladder
Employee Referral Program with Bonuses up to $10k
Certification Support and Pay
Relocation Assistance
Advancement Opportunities
Retirement Savings Program
Employee Assistance Program including free Mental Health
Same Day Pay through Daily Pay

SUMMARY

The central role of the RN Care Manager is a commitment to improve clinical outcomes in patient populations most at risk within practices and those at potential risk for adverse healthcare outcomes. The Registered Nurse works in collaboration with primary care providers and the multidisciplinary care team to identify and proactively manage the needs of patients with high risk or complex medical, behavioral health and/or psychological problems through practice, community and home-based visits and telephonic support. The RN Care Manager develops and implements a care management plan based on patient goals, preferences and disease states to promote improved health care outcomes and quality of life. The RN Care Manager links patients to appropriate community resources, facilitates referral to appropriate care services, supports patient self-management, and communicates with providers in order to reduce barriers to improved health care outcomes. The RN Care Manager serves as an integral member of the primary care practice's care team, assesses patients for risk of adverse health outcomes, and measures the impact of care management interventions. Provide superior customer service by modeling the Brand Promise and Core Values of the organization.

STATUS: Full Time

LOCATION: GIM @Alexander Park, Refugee Clinic @ Alexander Park

DEPARTMENT: Ambulatory Care Management

SCHEDULE: Monday-Friday, Days

ATTRIBUTES

BSN (preferred) or Associate's Degree in Nursing (ASN) and a Bachelor's Degree in another discipline
Minimum 405 years of clinical nursing experience: case management/utilization management/ discharge planning experience preferred
Must have a NYS driver's license
Progressive clinical experience including community health, care management, disease management or behavioral health preferred
Compassionate, warm and patient focused
Strong interpersonal skills
Experience working as a member of a multidisciplinary team
Ability to lead and facilitate a team approach to population-based care
Critical thinking skills, decisive judgement
Exceptional documentation skills and professional behavior
Excellent written and verbal communication skills
Ability to work independently in a fast-paced environment
Proficient computer skills Excel, Word, the Internet and Health Information Technology

RESPONSIBILITIES

Identify high risk populations that meet eligibility requirements for complex care management services using standard analytics and referral sources including reports and patient registries. Monitor and analyze utilization of health care services including IP, ED and 30-day readmission visit with appropriate follow up. Complete a comprehensive nursing assessment that includes assessment of the social drivers and other gaps or barriers to health. Develop an individualized, patient centered care management plan based on the patient's preferences and goals, strengths and barriers that promote improved health care outcomes and quality of life in collaboration with patient, family, caregivers and other members of the healthcare team. Identify resources and provide education to assist patients in developing self-management skills that considers the patient's health literacy level. Identify and utilize a network of resources within and without the healthcare system to promote effective care management.
Provide comprehensive transitional care involving coordination of care and services post critical events, such as emergency department use, hospital inpatient admission and discharge or skilled nursing facility admission and discharge.
Provide crisis intervention planning addressing events such as emergency department visits or inpatient admissions or other crisis events to ensure planned crisis interventions are effective.
Maintain the physical and technical security and privacy of protected health information (PHI) to maintain confidentiality
Facilitate patient referrals across the care continuum to meet individual patient needs
Interact effectively with PCPs/ providers and other members of the health care and/or community teams to implement patient interventions that mitigate barriers to healthcare.
Collaborate with Social Work partner on proactive patient outreach and assessment of high risk patients
Lead practice level care team rounds

EDUCATION:

LICENSES / CERTIFICATIONS:

BLS - Basic Life Support - American Heart Association (AHA), RN - Registered Nurse - New York State Education Department (NYSED)

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$65,000.00 - $95,000.00

CITY:

Rochester

POSTAL CODE:

14607

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.

Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.

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