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Outreach Nurse Liaison
2 months ago
We are seeking a highly skilled Outreach Registered Nurse Liaison to join our team at Northwell Health. As a key member of our home care organization, you will play a vital role in ensuring seamless transitions and coordination of care for patients moving from hospitals or other care settings to home care.
Key Responsibilities- Primary Point of Contact: Serve as the primary point of contact between patients, families, home care agencies, and healthcare providers to ensure effective communication and coordination of care.
- Patient Assessment: Assess patients' medical needs, home environment, and suitability for home care services to identify areas for improvement and develop personalized care plans.
- Clinical Evaluation: Evaluate patients' clinical information, including medical history, medications, and current health status to inform care decisions and ensure continuity of care.
- Transition of Care: Coordinate the transition of care from hospital to home, including arranging for necessary medical equipment, supplies, and home modifications to ensure a smooth transition.
- Care Planning: Collaborate with physicians, hospital staff, and home care teams to develop and implement personalized care plans that meet the unique needs of each patient.
- Patient Education: Educate patients and their families about the home care process, care plan, medications, and any specific medical instructions to empower them to take an active role in their care.
- Case Management: Facilitate referrals to appropriate home care services, such as nursing, physical therapy, occupational therapy, and social work to ensure comprehensive care.
- Documentation and Compliance: Ensure that all necessary documentation and authorizations are completed for home care services and maintain accurate and up-to-date records of patient assessments, care plans, communications, and services provided.
- Continuity of Care: Ensure continuity of care and address any issues or concerns that may arise during the home care process to maintain high-quality patient outcomes.
- Graduate of an accredited school of nursing and currently registered in New York State as a Registered Professional Nurse.
- Home care experience is a plus.
- Reliable vehicle to travel to patients.
Northwell Health offers a competitive salary and benefits package, as well as opportunities for professional growth and development in a dynamic and supportive work environment.