Remote Home Health Transitional Care Liaison, Weekend/Afternoon, PRN

Graham Healthcare Group•Lisle, IL

21h•Remote

About The Position

The Remote Home Health Transitional Care Liaison is responsible for facilitating patient transitions from healthcare facilities to home health services. This involves gathering comprehensive patient demographic and medical information, introducing Residential Home Health services, and coordinating the start of care visits. Key duties include ordering necessary medical equipment (DME), infusion services, and wound care, as well as providing patient education at the bedside and arranging post-discharge physician follow-up appointments. The liaison will also engage in community education, attend discharge planning meetings, assess the appropriateness of skilled home care or hospice services, and conduct follow-up calls with patients/caregivers. Communication with the clinical team is crucial for complex and chronically ill patients to prevent re-hospitalizations. The role requires diligent documentation within Residential’s EMR and partner EMR systems, and assisting with regulatory documentation.

Requirements

Demonstrates high skill set to work with varied groups and departments within the organization and with partners
Displays a high level of professionalism by exercising appropriate communication, patience, flexibility and a cooperative attitude
Able to provide excellent customer service
Effectively manages concurrent demands and multi-tasks to completion during the assigned shift
Detail orientated to manage complex situations and meet regulatory requirements
Maintains a consistent professional attitude with referral partners and patients
Associate Degree required
Minimum of one (1) year of experience in an acute care setting
Minimum of five (5) years of experience in a customer service capacity
Must have and maintain in good standing professional license, certificate or registration

Nice To Haves

Bachelor Degree preferred
One (1) year of experience in home health preferred

Responsibilities

Responsible for obtaining complete/accurate demographic information, medical history including diagnosis for care and primary care physician information
Responsible for introducing Residential Home Health to the patient/caregiver, explaining scope of our services, skilled services requested and coordinating start of care visit
Other duties include ordering requested DME, infusion services, and wound care
Community Education as requested by our sales to physician offices, assisted living facilities, including but not limited to educational in-services, blood pressure clinics and health fairs
Patient education at bedside, arranging post discharge physician follow up appointments, sharing important discharge information with the primary care physician
Attending discharge planning meeting as requested, working with the facility team to provide a safe and successful discharge home
Determining appropriateness of skilled home care services/hospice
One (1) week follow up customer service call to patient/caregiver when necessary
Communication with the Clinical team on all complex, chronically ill patients, assisting staff, referral sources in preventing re-hospitalizations
Complete documentation about the patient status and discharge plan with Residential’s EMR to facilitate communication and complete documentation within partner EMR when applicable
Assist in obtaining regulatory documentation as required
All other duties as assigned by supervisor