About The Position

Organizes and coordinates patient referrals for hospice from internal and external hospitals, skilled nursing facilities and other facility based hospice referrals. Coordinates all components of the hospice discharge process and acts as a key link between hospital referrals sources (i.e., AIM Navigators, Case Managers, physicians, DME, pharmacy, transport services and Hospice Intake staff). Ensures timely discharge of patient to place where patient will reside. For Transitions referrals from hospital, meets with patient/family to introduce Sharp Transitions Community Based Palliative Care program. Communicates and coordinates referrals with Sharp Hospice Care Intake.

Requirements

  • 1 Year Clinical nursing experience in acute, SNF, or community based care such as home health or hospice care.
  • 2 Years LVN experience.
  • Driver's License - CA Department of Motor Vehicles -REQUIRED
  • California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians -REQUIRED
  • Utilizes reliable transportation and possesses adequate personal insurance coverage.
  • Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.

Nice To Haves

  • Knowledge of hospice eligibility guidelines, familiar with insurance and related coverage requirements, effective communication and problem solving skills preferred.
  • Proficient use of computers and hospital IS applications such as CERNER required.
  • Will be driving between Sharp and external hospital/SNF facilities as needed.

Responsibilities

  • Contacts patient and families for all referral follow-up Facility Based Transitions Referrals Upon a referral from AIM, Medical Group Case Managers or Physicians, makes contact with patient/family to introduce program services and interest in this program. Coordinates Transitions referral with Sharp Hospice/Transitions Intake department if patient accepts Transitions post hospital discharge. Communicates decision with referral source.
  • Discharge planning Coordinates pharmacy, DME, and transportation services ensuring a safe and timely discharge. Informs AIM Navigators, hospital Case Managers, and physicians when discharge is ready to go. Ensures appropriate documentation resides in the medical record (per organizational protocol and policy.
  • Referral management Inpatient Hospice Referral Coordination Facilitates communication and care coordination with patient/family to ensure a safe discharge plan for hospice. Documents any special needs or requests the patient/family may have regarding the hospice discharge plan or related services Communicates with hospice supervisors or Hospice Home Manager as needed for clarification of eligibility or complex clinical issues where guidance is needed. Coordinates and communicates discharge plan with AIM Navigators, hospital Case Managers, and physicians as required. Communicates directly with Hospice Intake staff as needed to coordinate, clarify, and/or arrange for hospice services related to discharge including scheduling.
  • Teamwork Promotes positive communication, cooperation and assistance to co-workers, other healthcare providers and team members. Provides constructive feedback to peers and manager to facilitate conflict resolution. Exhibits the 12 Sharp Standards of Behavior in a positive and meaningful way.
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