Clinical Liaison RN - PAH

Position Summary

The Clinical Liaison RN - PAH is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders.

Providence at Home with Compassus

This position represents Compassus Providence JV (JV) Agencies at contracted Providence facilities and requires strong communication and interpersonal skills. The role of the Clinical Liaison RN is to coordinate and arrange home care services between Providence hospital facilities and the JV Agencies for home health and hospice, and other community providers when specifically requested by the patients.

The position acts as a clinical resource and educates hospital staff regarding the services offered by JV, and enhances the patient care plan as it relates to the discharge plan. The Clinical Liaison RN provides information to ensure a smooth transition for patients and their families following hospitalization. The Clinical Liaison RN may be assessed for success of achieving Value-Based Enterprise measures.

• Demonstrates ability to cope with ambiguous and changing environment.
• Demonstrates the ability to remain calm under pressure.
• Works well independently; able to work effectively without day-to-day supervision.
• To establish and maintain positive working relationships with facility customers and JV home health agency and hospice staff.
• To prioritize multiple tasks and work in a demanding, active setting.
• Understanding purpose and function of Value-Based Enterprise agreement between Providence and JV for home health and hospice care coordination.

• The job duties listed are essential functions of the position. However, other duties may be assigned, and may also be considered essential functions of the position.
• The caregiver must be sufficiently fluent in the English language to satisfactorily perform the essential functions of the position. The degree of fluency required will vary depending on the nature of the position.
• Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization.
• For direct patient care roles:
  Performs and maintains currency of essential competencies as required by specific area of hire and populations served.
• HOME HEALTH AND HOSPICE ADMISSIONS
• Assesses referrals for appropriateness for home care and hospice to include medical, physical, social, and emotional status, home environment and family's acceptance and ability to care for the patient in the home and determine the need for equipment.
• Coordinates discharge planning for hospital inpatients to home health and hospice service needs of referral sources including physicians and authorized mid-level practitioners (e.g., ARNP or PA) including but not limited to those who are hospital-based, work in clinics, physician offices or elsewhere in the community.
• Provides home care information/education at meetings with hospital service, utilization review/discharge planners/case managers, patients and patient's families and educates hospital medical and physician/mid-level staff, patients, and patient's families to available home care services.
• Acts as liaison between patients, families, payors, physicians, Providence discharge planners, and the network providing complete physicians' orders, referral information to the network intake department.
• Assumes initial responsibility with Hospital discharge planning team for assessing patient/family needs for Home Health, Hospice and consults with the attending physician, Hospice Medical Director, intake team and other staff members as necessary.
• Plans for admission of patients to Home Health, Hospice in coordination with agency representative, patient/family, Hospitalist and primary physicians/attendings, Medical Directors and hospital case manager/discharge planner.
• Contributes to the clinical determination of a patient's appropriateness for Home Health and Hospice services consistent with applicable policies and admission criteria and in conjunction with patient's physician or appropriate mid-level practitioner.
• Facilitates transition of patient/family to primary nurse and other members of the hospice Interdisciplinary Group (IDG) as indicated for patients who elect hospice after determined to be hospice eligible.
• Coordinate the expansion and implementation of the GIP (General Inpatient Care) Hospice Program in conjunction with hospice team.
• Attends appropriate meetings to promote Home Health and Hospice referrals and GIP as appropriate.
• Maintains and builds existing relationships with post-acute care providers by serving as a resource for education and information.
• Evaluates referrals received on hospitalized patient from a…