Care at Home Liaison

UT Southwestern Medical Center • Dallas, TX

1d

About The Position

The Care at Home Services Liaison acts as a central coordinator and advocate for patients transitioning from hospital or clinic settings into a variety of home-based care programs. This role supports remote patient monitoring, home infusion therapies, and other post-acute or specialized "care at home" services. By fostering strong referral relationships, ensuring smooth handoffs, and educating patients and families, the Liaison helps optimize clinical outcomes, regulatory compliance, and patient satisfaction across all home-based service lines.

Requirements

• 2 years experience in post-acute care, hospital discharge planning, case management, or a healthcare liaison role
• Proven ability to build and maintain professional relationships with referral sources

Nice To Haves

• Bachelor's Degree in Nursing, Healthcare Administration, Marketing, or related field
• Strong knowledge of home health services, CMS regulations, and OASIS processes
• (RN) REGISTERED NURSE or (LVN) LICENSED VOCATIONAL NURSE

Responsibilities

• Establish, cultivate, and maintain collaborative relationships with referral sources, including hospitals, physician practices, case managers, discharge planners, and community partners to support referral growth and patient access to Care at Home services.
• Serve as the primary point of contact for referral inquiries, care transition coordination, and patient placement needs.
• Promote Care at Home programs and services by educating referral partners, patients, families, and community stakeholders on available service lines, clinical specialties, eligibility criteria, and program benefits.
• Meet with patients and families to assess service needs, explain available home-based care options, answer questions, and ensure understanding of home health care options.
• Facilitate a smooth handoff from acute or ambulatory settings to Care at Home services.
• Address patient/family concerns promptly and escalate as appropriate.
• Initiate and / or complete the Intake, collaborate with scheduling, and clinical leadership to ensure timely admission and continuity of care.
• Verify that all documentation meets CMS Conditions of Participation, state regulations, and organizational policies.
• Track and follow up on referrals to ensure conversion to admission when appropriate.
• Review referral documentation for completeness, accuracy, and regulatory compliance, ensuring adherence to CMS Conditions of Participation, state regulations, accreditation standards, and organizational policies.
• Monitor referral trends and provide feedback on barriers to access.
• Ensure all referral documentation meets CMS Conditions of Participation, State regulations, and organizational policies.
• Serve as a patient advocate, address concerns promptly and escalate clinical issues when necessary.
• Maintain accurate and timely records of referral activity, contacts, and outcomes.
• Collaborate with operational, clinical, and business development leaders to support customer service excellence, patient satisfaction, and strategic growth initiatives.
• Analyze referral volume, conversion rates, and service utilization data to identify opportunities for growth, strengthen referral partnerships, and improve access to Care at Home services.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100%25 coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level