RN Clinical Care Manager

About This Role

This role integrates and coordinates access and utilization management, proactive patient management, care facilitation, and treatment planning functions within the Primary Care Network. You will coordinate the medical care of high-risk patients and assist in developing care plans for medically complex patients.

Responsibilities

• Coordinate medical care of patients identified as high risk through clinical determination or health risk assessments
• Assume a coordination role at the point of service and through targeted outreach and follow-up
• Identify patient groups with chronic diseases and assist in developing and implementing population-based strategies to close gaps in medical care
• Identify resources for patient self-management skills
• Assist in developing and implementing care plans for medically complex patients, ensuring alignment with patient needs
• Identify barriers to a successful care management path and develop strategies to overcome them
• Assist with planning short-range and long-range program goals for chronic disease management
• Participate in the development of evidence-based protocols, policies, workflows, guidelines, and flow sheets within the medical home model
• Coordinate use of clinical and ancillary resources within and outside of the health system to achieve treatment goals
• Hold accountability for patient triage, ensuring appropriate and timely care interventions

Requirements

• Bachelor's degree in Nursing or health related field
• 3 years of professional nursing experience
• RN licensure in NYS upon hire
• Current CPR certification upon hire
• Commutable range of Rochester

Qualifications

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

Nice to Have

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

Certifications