Welcome To Beth Israel Lahey Health at Home. Our team provides high-quality home care and hospice services by partnering with physicians, hospitals and skilled nursing facilities to provide specialized care to patients in the comfort of their own home. Our team of nurses, therapists (physical, occupational, and speech), medical social workers, and home health aides work together to devise and implement a compassionate care plan that is expressly tailored for each patient.
About the Job
Position Summary: Reporting to the Executive Director of Home Care Services, the Clinical Liaison is responsible for developing and maintaining relationships with referral sources and generating referrals to BILH at Home programs. The Clinical Liaison meets directly with patients, families, their caretakers, and/or case managers and performs a clinical assessment to determine appropriateness of referral.
Duties & Responsibilities including but not limited to:
- Identifies and follows through with new patient referrals for home health and hospice services as appropriate.
- Identifies and follows through with new patient referrals to skilled nursing facilities when appropriate.
- Reviews and evaluates patient’s medical record utilizing sound clinical judgment, knowledge of skill requirements, and reimbursement systems to ensure appropriateness and desirability of referral.
- When appropriate, meets with patients, family members and care takers to provide information about skilled nursing and/or home health and hospice services.
- Coordinates patient discharge plans with hospital case managers and hospitalists to ensure patient receives appropriate level of care and service.
- Communicates patient referral information to the appropriate admission or intake department ensuring accurate and complete information to facilitate continuity of care with a smooth transition from one care setting to another.
- As part of the clinical liaison service team, the Clinical Liaison works on-site at internal facilities providing liaison services. The Clinical Liaison adheres to the policies, procedures, and work schedule according to the facility(ies) they are assigned.
- Completes all clinical and administrative documentation in an effective and efficient manner using the current electronic medical record and e discharge system in keeping with established policies and procedures.
- Maintains confidentiality and compliance related to patient rights, HIPPA (Health Insurance Portability and Privacy Act), and other regulations and protocols related to dealing with health information privacy.
- Cultivates referral relationships with physicians, case managers, social workers, and other potential referrers.
- May assist with representing BILH and delivering professional educational programs to increase understanding of home health and hospice services with the goal of developing new referral sources.
- May attend meetings and clinical rounds at assigned referral sites.
- May represent BILH at community events, networking groups, professional membership organizations, health fairs and expositions, and other related activities.
- Travels locally to other BILH program sites, referral source sites, contracted facilities, community agencies and meetings as needed/requested.
- May participate in weekend and holiday rotation schedules as needed.
- Maintain strict adherence to the BILH at Home Confidentiality policy.
- Incorporate BILH at Home Standards of Behavior and Guiding Principles into daily activities.
- Comply with all BILH at Home Policies.
- Comply with behavioral expectations of the BILH at Home Division.
- Maintain courteous and effective interactions with colleagues and patients.
- Demonstrate an understanding of the job description, performance expectations, and competency assessment.
- Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
- Participate in departmental and/or interdepartmental quality improvement activities.
- Participate in and successfully completes Mandatory Education.
- Perform all other duties as needed or directed to meet the needs of the department.
- Registered Nurse from a Graduate of National League for Nursing accredited school of nursing
- BSN, strongly preferred
Licensure, Certification & Registration:
- Registered nurse with current licensure to practice professional nursing in the state of Massachusetts.
- Has an active American Health Association BLS. If no American Heart Association BLS the employee must complete an annual BILHAH BLS Competency. No other forms of BLS will be accepted.
- Two to five years of direct care experience in an acute care, home care, or senior care setting.
Skills, Knowledge & Abilities:
- Demonstrated clinical assessment skills with plan of care coordination experience, discharge planning, case management and patient advocacy preferred.
- Proficiency with site-based and remote access electronic health and medical records.
- Self-starter with solid organizational skills who can exercise independent judgment.
- Demonstrated ability to build and foster relationships, and work effectively with healthcare professionals both internal and external to LHSC.
- Highly-developed customer service, interpersonal, verbal, and written communication skills.
Physical Requirements & Environment:
Mental and Visual Attention
- The position requires a high degree of mental and visual concentration.
- Nature of work requires lifting or moving light weight (up to 20 pounds).
- Flow of work and nature of duties require average manual coordination.
- Range of Motion
- Responsibilities require average range of motion.
- Physical Conditions
- Performance of duties allows for variation in positioning and tasks.
- Repetitive Motion
- Responsibilities require occasional repetitive motion.
- Working conditions include continuous exposure to elements such as odor, noise, dust, chemicals, temperature extremes or airborne pathogens.
Exposure to Hazardous Materials
- Performance of duties frequently involves exposure to hazardous materials.
- Performance of duties requires the ability to discern and identify colors.
- Performance of duties requires the ability to discern sharp from dull and hot from cold.
- Performance of duties requires the ability to hear soft and loud noises.
The Lahey Model of Care—right care, right time, right place—is exactly what patients, providers and payers need and deserve. Identifying and delivering on this convergence of interests has positioned Lahey Health for further growth. Our model ensures care is highly coordinated and locally delivered, with lower costs and exceptional quality.
Lahey Health is a robust, regional system including a teaching hospital, community hospitals, primary care providers, specialists, behavioral and home health services, skilled nursing and rehabilitation facilities, and senior care resources throughout northeastern Massachusetts and southern New Hampshire. The system has a global presence with programs in Canada, Jordan and Bermuda.
Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.