RN Home Care Community Liaison / Hospice

Job Description :

Position : Clinical Nurse Liaison

The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have.

Location : HCBS - Dedham

Title of Immediate Supervisor : Senior Director, Home and Community-Based Services

Position Summary :

The Liaison enhances continuity of patient care by providing liaison between assigned locations (SNFs, ALs and other), physicians, and home care agency.

Position Responsibilities Include :

Transfers Patients from facility to HCBS service lines that include home health and hospice services by establishing and maintaining relationships with nurses, social services, physical and occupational therapy, and other support services.

Provides all necessary information concerning home care / hospice intake coordination and provides input related to clinical concerns for individual patients.

Resolves patient care issues by working one-on-one with Patient Care Managers to standardize patient home care assessments; collecting relevant information; conferring with co-care givers; assessing patient home care needs.

Keeps facility and attending physician informed of patient status by monitoring and reporting home care services rendered and / or modified; following up on patient reports and other patient information; anticipates additional home care services needed, i.e. wound therapy, physical therapy, social work and / or other specialties.

Promotes effective written / verbal communication daily.

Gives accurate information to patients and or families regarding home care and related issues.

Serves and protects home care / hospice by adhering to professional standards, policies and procedures, federal, state, and local requirements, and professional and licensing standards.

Promotes education for patients, their families and the community.

Assists in intake process by entering as much documentation as possible regarding patients transfer to home care / hospice

Updates job knowledge by participating in educational opportunities.

Keeps an accurate log of all discharges to home care from facility and submits completed log on monthly basis.

Serves as a resource and support to patients.

Identifies and responds to safety concerns of patients.

Maintains compliance with policies, procedures, and regulatory matters.

Promotes and maintains an agency environment that is in compliance with federal, state, and local regulatory agencies.

Participates in personal and professional growth and development including staff meetings and in-service education.

Communicates with patients, families, and other health professionals in a manner that conveys respect, caring, and sensitivity.

Communicates with the physician and / or nurse practitioner regarding patient status and medical intervention.

Contributes to HCBS program effectiveness by identifying short-term and long-range issues that must be addressed; providing information and commentary pertinent to deliberations; recommending options and courses of action; implementing directives

Enhances HCBS service reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Provides information by responding to queries of hospitals, nursing homes, attending physicians and their practice staffs, and other agencies; sorting and distributing messages and documents; answering questions and requests; preparing information for patient transfer; preparing statistical reports related to referral and intake activities from assigned locations maintaining databases.

Educates assigned location teams by attending team and community meetings; providing orientation / in-service programs concerning home care intake coordination and hospital relations; providing input relating to clinical concerns for individual patients.

Reflects the cultural Belief of Teaming Up with HSL peers including Intake Coordinators to optimize patient transitions.

Performs other duties and activities as delegated by the Supervisor and the Executive Director.

Markets HCBS services to HSL housing sites, hospitals, physician groups, ALFs, senior centers and at vendor fairs.

Performs patients screens at the request of referral sources

Attends networking events as requested

Qualifications :

Graduate of an Accredited School of Nursing.

Current License with Massachusetts State Board of Nursing.

Two years nursing experience preferred.

Good verbal and written communication skills.

Must be motivated to learn and flexible to change.

Computer literacy required.

Must be able to work independently.

Current CPR certification.

Remote Type

Salary Range :

$84,971.00 - $127,458.00