Lead Clinical Liaison RN

Company :

Providence at Home with Compassus

Position Summary

The Clinical Liaison serves as the primary connection between Providence hospital facilities, Compassus Providence Joint Venture (JV) Agencies, and community providers. This role coordinates and arranges home health and hospice services to ensure smooth patient transitions following hospitalization. The Clinical Liaison educates hospital staff about available services, assists patients and families in understanding care options, and collaborates with discharge planners, physicians, and care teams to develop and implement patient-centered discharge plans.

Position Specific Responsibilities

• Evaluate referrals for appropriateness for home health and hospice, including medical, social, emotional, and environmental factors, and determine any equipment needs.
• Coordinate discharge planning with physicians, advanced practice providers, case managers, and other referral sources to ensure timely and appropriate transitions.
• Provide education to hospital staff, patients, and families regarding available home health and hospice services and care options.
• Serve as liaison between patients, families, physicians, payors, Providence discharge planners, and JV agencies, ensuring accurate and complete documentation and orders are submitted.
• Collaborate with hospital discharge planning teams to assess patient and family needs and consult with physicians, Hospice Medical Directors, intake staff, and other team members as needed.
• Facilitate admissions to home health and hospice, including obtaining required consents and election statements, and ensure a smooth handoff to agency staff, including the hospice Interdisciplinary Group (IDG).
• Support the expansion and implementation of the General Inpatient Care (GIP) Hospice Program in collaboration with hospice teams.
• Discharge hospice GIP patients from the hospital to home, skilled nursing facilities, or assisted living facilities as appropriate, coordinating with the JV hospice care team.
• Provide hospital staff and physicians with education regarding end-of-life care, hospice, and GIP services.
• Document activities in the Providence and JV electronic medical records systems and track referral outcomes by nursing unit and JV agency.
• Follow up on referrals to ensure all services and products are arranged.
• Participate in strategic initiatives to support Value-Based Enterprise (VBE) care coordination and discharge planning for post-acute patients.
• Attend meetings with hospital service teams, utilization review / discharge planners, and case managers to promote home health and hospice referrals.
• Maintain and build relationships with post-acute care providers by serving as a resource for education and information.
• Acquire and maintain knowledge of managed care contracts and network provider subcontracts.
• Promote and uphold the Patients' Bill of Rights and Responsibilities and follow procedures for documenting and addressing grievances.

Education and / or Experience

Certifications, Licenses, and Registrations

Physical Demands and Work Environment : The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 50 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. In a healthcare setting, exposure to bodily fluids, infectious diseases, and conditions typical to the field is expected. Routine use of standard medical equipment and tools associated with clinical care is essential. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to clinical positions in our organization.

At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Pay Range : $53.25 - $82.68 per hour

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