As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

135 Corporate Woods, Rochester, New York, United States of America, 14623

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

500912 Primary Care Administration

Work Shift:

Range:

UR URCE 214

Compensation Range:

$76,398.00 - $99,320.00

Responsibilities:

GENERAL PURPOSE
Integrates and coordinates access and utilization management, proactive patient management, care facilitation, and treatment planning functions for the Primary Care Network. Coordinates the medical care of high-risk patients identified through health risk assessment/appraisal or physician clinical determination. Provides targeted outreach and follow-up, assisting in care plan development for medically complex patients, and identifying barriers to successful care management.

Must be within a commutable range of Rochester.

ESSENTIAL FUNCTIONS

• Coordinates medical care of patients identified as high risk through clinical determination or health risk assessments. 

• Assumes a coordination role at the point of service and through targeted outreach and follow-up. 

• Identifies patient groups with chronic diseases and assists in developing and implementing population-based strategies to close gaps in medical care. 

• Identifies resources for patient self-management skills. 

• Assists in developing and implementing care plans for medically complex patients, ensuring alignment with patient needs.

• Identifies barriers to a successful care management path and develops strategies to overcome them.

• Assists with planning short-range and long-range program goals for chronic disease management. 

• Participates in the development of evidence-based protocols, policies, workflows, guidelines, and flow sheets within the medical home model. 

• Participates in committees as assigned. 

• Keeps abreast of organizational developments and practices that may impact operations by engaging in continuing education, professional organizations, seminars, and relevant literature.

• Coordinates use of clinical and ancillary resources within and outside of the health system to achieve treatment goals specified in the patient care plan. 

• Interacts effectively with physicians, home care teams, patients, and their caregivers. 

• Holds accountability for patient triage, ensuring appropriate and timely care interventions.

• Adheres to infection control and safety guidelines. 

• Ensures compliance with HIPAA, The Joint Commission (TJC), and Occupational Safety & Health Administration (OSHA) regulations and policies.

Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

• Bachelor's degree in Nursing or health related field and 3 years of professional nursing experience required

• Or equivalent combination of education and experience

• Experience with ambulatory care in community health, care management, disease management, quality improvement and/or management preferred

LICENSES AND CERTIFICATIONS

• RN  - Registered Nurse - State Licensure and/or Compact State Licensure, Licensure in NYS upon hire required

• Cardiopulmonary Resuscitation (CPR) current certification upon hire required

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.