Job DescriptionWe are looking for a Outreach Registered Nurse Liaison to work for one of our clients, a multi-service license home care organization. In this role you would be traveling between adult homes to assist the agency staff and administrators in collaboration with MD's to assess for new admissions, hospitalizations, residents that need CHHA service. Will serve as a bridge between patients and home care services. The role involves ensuring smooth transitions and coordination of care for patients moving from hospitals or other care settings to home care. An ideal candidate would be a graduate of accredited school of nursing, and currently registered in New York State as a Registered Professional Nurse. Home Care experience is a plus. Must have a reliable vehicle to travel to patients.Responsibilities include, but not limited to:
- Serving as a primary point of contact between the patient, family, home care agency, and healthcare providers.
- Assessing patients' medical needs, home environment, and suitability for home care services.
- Evaluating patients' clinical information, including medical history, medications, and current health status.
- Coordinating the transition of care from hospital to home, including arranging for necessary medical equipment, supplies, and home modifications.
- Collaborating with physicians, hospital staff, and home care teams to develop and implement personalized care plans.
- Educating patients and their families about the home care process, care plan, medications, and any specific medical instructions.
- Providing guidance on managing chronic conditions, wound care, medication administration, and other necessary skills.
- Facilitating referrals to appropriate home care services, such as nursing, physical therapy, occupational therapy, and social work.
- Ensuring that all necessary documentation and authorizations are completed for home care services.
- Ensuring compliance with healthcare regulations, standards, and best practices.
- Managing complex cases, including coordinating with multiple healthcare providers and services.
- Ensuring continuity of care and addressing any issues or concerns that may arise during the home care process.
- Maintaining accurate and up-to-date records of patient assessments, care plans, communications, and services provided.
- Reporting to healthcare providers and home care agencies on the patient's progress and any changes in their condition.
*Additional Salary DetailThe salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g. location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).