Post-Acute Clinical Liaison - Home Health - Days

Full Time (80 Hours Biweekly)

Day Shift

General Summary

Coordinates patient care/services in the assigned setting to encompass a thorough continuum of quality care to improve patient outcomes.

Duties and Responsibilities

Essential Functions:

• Introduces patient to WellSpan Home Health and Hospice Services.
• Completes and documents a thorough assessment/screening for patients to determine the appropriate post-acute setting while maximizing independence with their care.
• Serves as a consistent contact for patient/family throughout the process of diagnosis and treatment.
• Serves as a liaison between the patients, families and healthcare team during hospitalization and the immediate post-discharge period.
• Provides individualized information, support, and education including infusions, wound care, enteral feedings.
• Provides recommendations for additional post-acute support as appropriate for Advanced Illness Management and Remote Patient monitoring services.
• Follows patient via contact with applicable WellSpan staff.
• Participates in interdisciplinary nursing rounds for inpatients (discharge planning process).
• Reinforces pre- and post-operative instructions and provides further education as appropriate.
• Maintains two-way communication with providers’ offices in order to improve the process of coordinating care for patients.
• Responsible for the guidance and coordination of care for patients and their caregivers through the continuum of care.
• Reports outcome of nursing/patient care/coordination activities to appropriate leadership.
• Collaborates with outreach/education coordinators for all service lines in the preparation and delivery of community and professional education programs.
• Revises and monitors educational materials to ensure that they are coordinated, understandable, and meet the PFEAT standards.
• Protects patient confidentiality by promoting professional staff communications.

Common Expectations:

• Demonstrates a commitment to patient, visitor and staff by: complying with all applicable safety regulations; learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and "error proof" systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
• Demonstrates knowledge of the principles of growth and development over the life span of the assigned patient population. Assesses and interprets patient age specific data and provides appropriate, age specific treatment. Provides direct patient care to assigned patient age group(s).
• Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Responsible for the care and maintenance of department/entity equipment and supplies.
• Attends meetings as required and participates on committees as requested.

Required for All Jobs:

• Performs other related duties as identified.
• WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
• WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Physical Demands:

• Standing - Occasionally
• Walking - Occasionally
• Sitting - Frequently
• Reaching - Rarely
• Talking - Frequently
• Hearing - Frequently
• Repetitive Motions - Occasionally
• Eye/Hand/Foot Coordination - Occasionally

Qualifications

Minimum Education:

• Associates Degree Required
• Bachelors Degree Preferred

Work Experience:

• 3 years Experience in Nursing and related experience. Required

Licenses:

• Licensed Registered Nurse Upon Hire Required or
• Registered Nurse Multi State License Upon Hire Required and
• Basic Life Support Upon Hire Required

Driver's License Statement:

Must possess a valid driver's license in the current state of residence. Driving record must meet requirements established by WellSpan Risk Management.

Courses and Training:

• Certification in appropriate nursing specialty. Upon Hire Preferred

Knowledge, Skills, and Abilities:

• Highly organized.
• Advanced Microsoft Office and other computer skills.
• Excellent professional written and verbal communication skills.
• Knowledge of medical terminology.
• Ability to work independently and as an integral part of a collaborative team.
• Proven outstanding interpersonal skills.
• Demonstrated ability to function as a team player.