Transition Care Liaison, Home Health (hospital based nurse)

Why You'll Love Being a Transition Care Liaison at AccentCare

Do you take great pride in achieving the best possible outcomes for patients? Are you passionate about providing exceptional care? Join the AccentCare team today as a Transition Care Liaison.

As a Transition Care Liaison, you will have the ability to work at the top of your licensure while working one-on-one with your clients to provide them with customized care. Under the guidance of your physician, you will develop plans of care and utilize nursing theories, skills, and techniques to provide quality care to your clients on a daily basis.

When you join AccentCare, you become part of a team that is not only dedicated to their patients, but to each other as well. Here, you will truly make a difference each and every day as you work alongside a supportive team. With a competitive benefits package, work-life balance, professional development, and an outstanding work environment, you will have everything you need to achieve success in your career. Bring your passion for patient care and you will build a career you love as a Transition Care Liaison.

Join the AccentCare team and apply for this Transition Care Liaison opportunity today!

Offer Based on Years of Experience

Transition Care Liaison Responsibilities:

• Manages the communication channels between physicians, social workers, discharge planners, hospital case managers, Patient Care Navigators, and agency staff by ensuring that all are aware of referral source requests and concerns; communicating information, questions, and status reports from the patient care staff to the referral source; establishing a system for handling non-admits and communicating this information to the referral source. Clinically assesses, coordinates and communicates care needed and relays concerns of physician and hospital staff prior to home care admission or resumption of care to the agency staff and during course of treatment.
• In partnership with the discharge planner and/or physician, conducts bedside visits with the patient, preferably in person (may be done telephonically) to assess, facilitate and drive a successful transition to home for the patient and family. Provides input and clinical expertise into patient transition and care plan development.
• Builds and maintains patient relationships by keeping close contact with hospitalized agency patients to ensure optimal patient experience. Transitions patient to Patient Care Navigators to establish physician follow up post discharge and ongoing care.
• Procures physician signatures on written orders regarding patient care and communicates to agency staff; maintains a current referral base of all referral sources within the service area.
• Collects and provides all information that is relevant to the patient care plan, including demographics, clinical data, payer, and other information, as required, on company approved forms to support diagnosis and home care orders. Assists agency in timely processing of physician orders.
• Manages and grows referral sources by identifying new referral sources and educating them on available services provided by the agency, maintaining current referral source relationships. Informs hospital personnel, patient and/or family of case acceptance.

Transition Care Liaison Qualifications:

• Bachelor's degree and 3 years of experience; or equivalent combination of education and experience. Advance degree preferred.
• 3 - 7 years of experience in facility/physician relationships with a deep understanding of facility discharge processes
• Licensed RN, LVN or PT in practicing state
• Current driver's license and liability insurance