Jobs in Punta Gorda, FL

About The Position

Requirements

• Active, unrestricted licensure in one of the following: Registered Nurse (RN) Licensed Clinical Social Worker (LCSW) Social Worker (SW) or equivalent clinical licensure
• Experience with home visits required
• 3+ years of experience in hospice, palliative care, care management, or complex care coordination
• Strong understanding of hospice eligibility criteria, end-of-life care planning, and goals-of-care discussions
• Demonstrated ability to navigate sensitive conversations with empathy, clarity, and professionalism
• Experience working within a value-based care or managed care environment preferred

Responsibilities

• Serve as the primary day-to-day clinical point of contact for hospice partners, ensuring strong collaboration and seamless care coordination.
• Coordinating Monthly Joint operating meetings with local hospices in collaboration with MPG clinical and administrative teams.
• Receive, triage, and manage hospice referrals from Primary Care Providers (PCPs) and Care Management teams, prioritizing based on clinical need and urgency.
• Assess and validate hospice eligibility in alignment with hospice partner criteria, using clinical judgment and available patient data.
• Lead initial and ongoing goals-of-care conversations with patients, families, and caregivers, providing education on prognosis, hospice services, and end-of-life options in a compassionate, patient-centered manner.
• Own and drive the end-to-end hospice referral process—from initial patient engagement through hospice acceptance—ensuring timely progression and clear communication across all stakeholders.
• Maintain proactive engagement with eligible but not yet ready patients, using clinical insight and relationship-building to revisit conversations as conditions evolve.
• Work closely with Clinical Operations and Healthcare Economics to actively track and quantify opportunity. This includes building, maintaining, and routinely reviewing a dashboard that clearly outlines performance, gaps, and targets.
• Actively use information to drive alignment, and ensure action is being taken at the care team level.
• Connect patients and families who are not eligible for hospice to other Millenium and community resources
• Navigate and operate effectively within the Millennium Physician Group ecosystem, understanding patient flow, referral pathways, and internal coordination across clinical teams.

Benefits

• Health, Dental, and Vision Insurance
• 401(K) Retirement Plan with Matching
• Short & Long-Term Disability
• Employer-Paid Life Insurance
• Paid Time Off, Floating Holidays, and Paid Major Holidays
• Employee Assistance Program (EAP)