Home Care Liaison Nurse/TAR Weekends and Holidays

Rochester, NY


Position Title:

Home Care Liaison Nurse/TAR Weekends and Holidays


Social Work and Patient and Family Services

Clinical Area :


Supervised by:

Home Care Liaison Team Manager

Description of Patient Population:

Ages Served: All Ages

X Neonatal

X Pediatric 1-12

X Adolescent 12-18

X Adult(s) 18 yrs and 65yrs

X Geriatric > 65yrs

Qualification :

RN with Home Care Coordination Experience required, 5 years acute hospital experience preferred. BS/MSN and acute care, community health, care management and/or disease management, multidisciplinary team experience preferred or an equivalent combination of education and experience. Registered in New York State.

General Description :

The Home Care Liaison Nurse/TAR is assigned to all inpatient clinical areas. The Home Care Liaison nurse reviews the medical record and collaborates with the Interdisciplinary Team and the Care Coordinator to facilitate discharge management. The patient discharge requirements will be met within the scope of Home Care Referrals and Patient Review Instruments (PRI) for nursing home placement.

Machines and equipment:

  • Hospital databases: E-Record

  • Email, copier, fax, and other related office tools; lab coat, ID, pager.

  • Discharge referral database, Electronic PRI

Specific Responsibilities:

Home Care Liaison Responsibilities : 95%

  • Identification of patients requiring Home Care Services after discharge

  • Contact of and communication with Home Care Agency per patient/family choice

  • Preparation of Home Care Referral Form

  • Faxing of Referral Form and other pertinent documents related to patient’s history

  • Obtaining outside vendors for IV Medications, Tube Feedings, DME/other needed equipment

  • Arranges with vendor teaching sessions for appropriately identified patient support system

  • Appropriate Documentation in the Medical Record of Discharge Plan

  • PRI Completion

  • Interdisciplinary Collaboration

  • Documentation in hospital and departmental databases

  • Home Health Care Referral Management (non-Monroe County)

  • Secure Specialty Equipment as indicated

  • Complete Discharge review to prevent unplanned readmissions. 2%

  • Attends Bi-weekly Home Care Liaison Team and Patient Family Services Meetings as able 2%

Other duties as assigned. 1%

Professional Evaluation/Supervision and Accountability:

Home Care Liaison Nurse is accountable to the Home Care Liaison Team members, Home Care Liaison Team Manager and Director of Social Work and Patient and Family Services

Home Care Liaison Nurse evaluations occur annually, with commentary from clinical colleagues and managerial staff.

Position Description maintenance:

This position description is reviewed at 6 months the first year and annually by the Home Care Liaison Team Manager, staff and Director of Social Work and Patient and Family Services

The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion 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 status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.

How To Apply

All applicants must apply online.

EOE Minorities/Females/Protected Veterans/Disabled

Pay Range

Pay Range: $ 68,640 - $ 89,232 Annually

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Location: Strong Memorial Hospital
Full/Part Time: Full-Time
Opening: Time as Reported Grade 044 Acute Care Coordinators