Nurse Liaison For Home Care

Job Description: Position: Clinical Nurse Liaison
Location: HCBS - Dedham Title of Immediate Supervisor: Senior
Director, Home and Community-Based Services Position Summary:
  The Liaison enhances continuity of patient care by providing
liaison between assigned locations (SNFs, ALs and other),
physicians, and home care agency. Position Responsibilities
Include: Transfers Patients from facility to HCBS service lines
that include home health and hospice services by establishing and
maintaining relationships with nurses, social services, physical
and occupational therapy, and other support services. Provides all
necessary information concerning home care/hospice intake
coordination and provides input related to clinical concerns for
individual patients. Resolves patient care issues by working
one-on-one with Patient Care Managers to standardize patient home
care assessments; collecting relevant information; conferring with
co-care givers; assessing patient home care needs. Keeps facility
and attending physician informed of patient status by monitoring
and reporting home care services rendered and/or modified;
following up on patient reports and other patient information;
anticipates additional home care services needed, i.e. wound
therapy, physical therapy, social work and/or other specialties.
Promotes effective written/verbal communication daily. Gives
accurate information to patients and or families regarding home
care and related issues. Serves and protects home care/hospice by
adhering to professional standards, policies and procedures,
federal, state, and local requirements, and professional and
licensing standards. Promotes education for patients, their
families and the community. Assists in intake process by entering
as much documentation as possible regarding patients transfer to
home care/hospice Updates job knowledge by participating in
educational opportunities. Keeps an accurate log of all discharges
to home care from facility and submits completed log on monthly
basis. Serves as a resource and support to patients. Identifies and
responds to safety concerns of patients. Maintains compliance with
policies, procedures, and regulatory matters. Promotes and
maintains an agency environment that is in compliance with federal,
state, and local regulatory agencies. Participates in personal and
professional growth and development including staff meetings and
in-service education. Communicates with patients, families, and
other health professionals in a manner that conveys respect,
caring, and sensitivity. Communicates with the physician and/or
nurse practitioner regarding patient status and medical
intervention. Contributes to HCBS program effectiveness by
identifying short-term and long-range issues that must be
addressed; providing information and commentary pertinent to
deliberations; recommending options and courses of action;
implementing directives Enhances HCBS service reputation by
accepting ownership for accomplishing new and different requests;
exploring opportunities to add value to job accomplishments.
Provides information by responding to queries of hospitals, nursing
homes, attending physicians and their practice staffs, and other
agencies; sorting and distributing messages and documents;
answering questions and requests; preparing information for patient
transfer; preparing statistical reports related to referral and
intake activities from assigned locations maintaining databases.
Educates assigned location teams by attending team and community
meetings; providing orientation/in-service programs concerning home
care intake coordination and hospital relations; providing input
relating to clinical concerns for individual patients. Reflects the
cultural Belief of Teaming Up with HSL peers including Intake
Coordinators to optimize patient transitions. Performs other duties
and activities as delegated by the Supervisor and the Executive
Director. Markets HCBS services to HSL housing sites, hospitals,
physician groups, ALFs, senior centers and at vendor fairs.
Performs patients screens at the request of referral sources
Attends networking events as requested Qualifications : Graduate of
an Accredited School of Nursing. Current License with Massachusetts
State Board of Nursing. Two years nursing experience
preferred.  Good verbal and written communication skills. Must
be motivated to learn and flexible to change. Computer literacy
required. Must be able to work independently. Current CPR
certification. Remote Type Salary Range: $84,971.00 -
$127,458.00