Care Transition Liaison-Home Health

Summary

The Care Transition Liaison (CTL) within a facility or physician's office acts as a resource for all patients referred to home health or hospice. The CTL will facilitate transition of patients between referring physician or host hospital to LHC agency. The CTL will educate the patient and/or family on HH and/or Hospice practices and confirm acceptance of the agency based on the ability to meet patient needs. The CTL acts as a support position to the Care Transition Coordinator or Account Executive within a facility.

RN, LPN, PTA, or COTA required

Responsibilities

• Facilitate referral of new/ existing patients to home health agency following Right of Choice

• Following choice, collaborates with Physician and/ or Case Manager in identifying the referred patient's needs and obtains approval for admission from LHC agency

• Obtains appropriate medical record information needed and sends to appropriate agency

• Coordinates start of care between hospital/ Physician and LHC agency

• Under the direction of the branch, collaborates with appropriate CM and/ or Physician for completion of order sets needed to facilitate admission

• If license allows, reduce to writing any verbal orders received from physician and follow up to have orders signed by physician

• For physician office referrals, assists with processing requests to the physician for medication refills for patients admitted to LHC Agency, when applicable, based on licensure of employee

• Communicates to Executive Director any complaints/ concerns from the Physician office/ Host Hospital. The Executive Director will follow up to ensure issues are handled appropriately

• Serves as a resource to the CM, Physician office, and patient as it relates to services that Home Health can provide

• Responsible for documenting activities and productivity within available systems including, but not limited to Marketscape CRM and/or HomeCare HomeBase.

• All other duties assigned by manager

Education and Experience

• Prior hospital, Physicians office, Home Health, or Hospice experience preferred

• LPN / LVN or licensed medical professional preferred

• Current Drivers license, vehicle insurance, and access to a dependable vehicle or public transportation