Hospice & Home Care Referral Nurse

PD Home Care & Hospice Referral Specialist, RN

Description

Are you an experienced Registered Nurse with a passion for hospice, home care, and care coordination? Atlantic Visiting Nurse is seeking a compassionate and clinically experienced Home Care & Hospice Referral Specialist RN to join our Care Access Center.

In this highly collaborative role, you'll serve as the clinical bridge between hospitals, physicians, patients, families, and our home care and hospice teams. You'll assess referrals, determine the appropriate level of care, coordinate admissions, and ensure patients receive timely, compassionate services that support safe transitions from hospital to home.

If you thrive in a fast-paced environment, enjoy building relationships, and want to positively impact patients during some of life's most important moments, we'd love to hear from you.

Principal Responsibilities:

• Conduct comprehensive clinical assessments to determine patient eligibility for Home Care or Hospice services.
• Review medical documentation to ensure referrals meet admission criteria and regulatory requirements.
• Meet with patients and families to educate them on Home Care and Hospice services, benefits, and care philosophy.
• Collaborate with physicians, case managers, discharge planners, and interdisciplinary teams to coordinate seamless transitions of care.
• Complete timely referrals and documentation within Epic.
• Coordinate durable medical equipment and other services needed prior to discharge.
• Participate in interdisciplinary care planning and clinical case discussions.
• Support accurate diagnosis coding and documentation.
• Monitor referral activity and contribute to departmental growth initiatives.
• Maintain current knowledge of home care regulations, hospice standards, reimbursement guidelines, and payer requirements.
• Serve as a clinical resource for referral specialists, physicians, and internal stakeholders.