Location: Canandaigua,NY, USA
DescriptionLooking to use your nursing skills in more of an administrative capacity with full time hours, M-F, days in a healthcare system that makes the patients and YOU the #1 priority? Thompson Health is the place for you!Main Function:Work in conjunction with a care team to identify and proactively manage the care needs of high risk patients within the primary care practice settingProvides assessment, care coordination, advocacy and coaching for identified patients that are at risk for hospital admissions or emergency room visits.Uses established Finger Lakes Health System Agency (FLHSA) CMMI grant criteria to identify at-risk patientsDetermines the drivers of risk in conjunction with the patient, family, physician and ancillary health care providersMeasures the impact of care coordination interventions, and regularly re-assesses the patient's risk for incurring adverse health outcomesRequired Job Specific Competencies:Ability to develop and support a practice based care management model by providing on-site and telephonic services i.e. wellness, health coaching, self-management techniques, disease management and case management including coordination with community services per FLHSA standardsIdentifies high risk patients needing care management servicesProvides education, support and outreach to patients over the phone and in person ensuring all aspects of FLHSA programs are met for family practicesInteracts closely with clinical teams to identify care gaps and improve clinical outcomes for patients with chronic conditions such as diabetesActive support for Thompson Practices quality programs, including PCMH and Diabetes Recognition ProgramScans the medical literature routinely for updates on clinical practice guidelines, new developments in the management of chronic diseases and communicates and disseminates information to staffComplies with all required Joint Commission, state and federal regulationsQualifications: (Licenses, Certifications)Current New York State Registered Nurse license requiredBLS certificationProficient in the use of Electronic Medical Records (EMR);Ability to create reports on own and interface with EMR vendor to develop reports where none currently existCompetent in Microsoft Office products (Word, Excel, Outlook, PowerPoint)Effective oral and written communication skillsPatient Centered Medical Home and Diabetes Recognition Program knowledge and experience a plusExperience:Preferred Experience: 3- 5 years of clinical nursing or social work experience, preferably with 3-5 years of community health experience, with the adult populationElectronic Medical Record experience requiredExperience with database entry and reporting preferredCare Management experience preferredEducation:Valid NY state nursing licenseA graduate of an approved school of nursingBSN requiredPosition Pay Range: $70,000-88,000 per yearStarting Pay: Based on experienceThompson Health is an EOE encouraging women, minorities, individuals with disabilities and veterans to applyEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)