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Health Home Care Coord

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University of Rochester

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Location:
United States of America , Brighton

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Category:
Health and Beauty

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Contract Type:
Employment contract

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Salary:

23.51 - 30.16 USD / Hour
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Job Description:

Provides professional comprehensive care management services to patients of specific locations and/or programs. Collaborates with health, behavioral health, and social service providers and is responsible for assessing patient's needs, developing and managing care plans with patients enrolled in care management. Special focus in serving the most complex, high utilizing patients that need comprehensive care management services. Services include, but are not limited to: care coordination, heath promotion, comprehensive transitional care, enrollee and family support, referral to community and social supports, use of technology to link services.

Job Responsibility:

  • Provides professional comprehensive care management services to patients
  • Collaborates with health, behavioral health, and social service providers
  • Assess patient's needs
  • Develop and manage care plans with patients enrolled in care management
  • Special focus in serving the most complex, high utilizing patients
  • Services include care coordination, heath promotion, comprehensive transitional care, enrollee and family support, referral to community and social supports, use of technology to link services
  • Develops a comprehensive Care Management Care Plan
  • Interacts with patients via telephonic outreach and in-person encounters
  • Conducts assessments
  • Develops, reviews and discusses plans with patient and care team
  • Utilizes community and family resources to create sustainable support systems
  • Performs complex care management services consistent with all URMC and NYS Regulations and Policies
  • Establishes and maintains cooperative working relationships with community providers
  • Coordinates outreach and engagement activities
  • Completes timely and thorough documentation of services in electronic medical records
  • Monitors utilization of services and encourages enrollees to follow treatment recommendations
  • Partners with patients and community providers to reduce unnecessary emergency and inpatient services
  • Supports patient in transitions of care

Requirements:

  • Bachelor's degree in an appropriate human services field
  • 1 year of experience in providing direct services to people with serious mental illness, intellectual/developmental disabilities, alcoholism/substance abuse, or experience effectively linking people with services that address social determinants of health
  • Valid driver's license with satisfactory driving record and access to an automobile

Additional Information:

Job Posted:
February 21, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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