Clinical Care Partner I

Compassus•Olympia, WA

4d•$29 - $43•Onsite

About The Position

The Clinical Care Partner I coordinates safe, efficient, and patient-centered transitions of care for hospitalized patients. The role evaluates patients for appropriate post-acute home-based care services and supports timely, high-quality discharge planning in collaboration with physicians, case management, patients, families, and post-acute providers. It aims to improve patient outcomes, reduce length of stay and readmissions, and ensure patients receive the right care in the right setting at the right time. This is an in-person position involving bedside engagement, interdisciplinary collaboration, and active participation in discharge planning workflows. The schedule is 8 a.m.–5 p.m., either Sunday–Thursday or Tuesday–Saturday. An active LPN, LVN, or equivalent license is required.

Requirements

Associate’s degree in Nursing, Health Sciences, or a related field.
Active and unencumbered LPN, LVN, or equivalent designation applicable to the regulatory requirements of the state of employment.
Current CPR certification.
Compliance with all joint-venture hospital partner occupational health requirements.
Ability to read, analyze, and interpret clinical documentation, professional journals, technical procedures, and governmental regulations.
Ability to write reports, business correspondence, and procedure manuals, and to present information and respond to questions from leaders, teammates, patients, families, and external parties.
Strong written and verbal communication skills.
Ability to understand, read, write, and speak English.
Ability to manage multiple projects simultaneously and meet deadlines.
Ability to design accessible and inclusive learning experiences for a diverse workforce.

Nice To Haves

Bachelor’s degree in Nursing, Health Sciences, or a related field.
Two to three years of experience in care coordination, discharge planning, or healthcare services.
Hospital, home health, hospice, or post-acute care experience.
Experience with EMR systems such as Epic and referral platforms.

Responsibilities

Evaluate patients for home-based and post-acute care services using clinical, functional, psychosocial, and environmental factors.
Review inpatient referrals, prioritize patients using clinical judgment and predictive analytics tools, and collaborate with physicians and care teams on appropriate level-of-care decisions.
Identify patients appropriate for value-based post-acute care services.
Coordinate timely, safe, and appropriate hospital discharge planning and develop individualized transition-of-care plans.
Partner with physicians, advanced practice providers, case management, and nursing teams.
Arrange post-acute services, including home health, hospice, durable medical equipment, medications, and follow-up care.
Ensure accurate and timely patient handoffs to post-acute providers.
Educate patients and families about post-acute care options, care expectations, and available services; provide bedside education supporting informed choice and shared decision-making.
Educate hospital staff and clinical stakeholders on post-acute pathways, referral processes, value-based care principles, and site-of-care selection.
Liaise between hospital teams and post-acute providers, maintain relationships with clinical stakeholders, participate in interdisciplinary rounds and discharge-planning discussions, and strengthen referral partnerships.
When applicable, identify patients appropriate for hospice or General Inpatient (GIP) care; coordinate hospice evaluations, eligibility determinations, and admissions; support end-of-life transitions; and ensure alignment with hospice eligibility and physician certification requirements.
Document care coordination activities in the electronic medical record and manage referrals through hospital and post-acute referral systems.
Use clinical decision-support tools and predictive analytics platforms, and track referrals, outcomes, and transitions across systems.
Support value-based care performance goals and key performance indicators, including length of stay, readmissions, mortality, timely initiation of care, referral-to-admit rate, and referral quality and documentation accuracy.
Participate in quality-improvement and workflow-optimization initiatives and support efforts to improve post-acute network performance and patient outcomes.