Home Care Liaison LPN

Clinical Liaison
The Clinical Liaison serves as the primary connection between Providence hospital facilities, Compassus Providence Joint Venture (JV) Agencies, and community providers. This role coordinates and arranges home health and hospice services to ensure smooth patient transitions following hospitalization. The Clinical Liaison educates hospital staff about available services, assists patients and families in understanding care options, and collaborates with discharge planners, physicians, and care teams to develop and implement patient-centered discharge plans.
Evaluate referrals for appropriateness for home health and hospice, including medical, social, emotional, and environmental factors, and determine any equipment needs.
Coordinate discharge planning with physicians, advanced practice providers, case managers, and other referral sources to ensure timely and appropriate transitions.
Provide education to hospital staff, patients, and families regarding available home health and hospice services and care options.
Serve as liaison between patients, families, physicians, payors, Providence discharge planners, and JV agencies, ensuring accurate and complete documentation and orders are submitted.
Collaborate with hospital discharge planning teams to assess patient and family needs and consult with physicians, Hospice Medical Directors, intake staff, and other team members as needed.
Facilitate admissions to home health and hospice, including obtaining required consents and election statements, and ensure a smooth handoff to agency staff, including the hospice Interdisciplinary Group (IDG).
Support the expansion and implementation of the General Inpatient Care (GIP) Hospice Program in collaboration with hospice teams.
Discharge hospice GIP patients from the hospital to home, skilled nursing facilities, or assisted living facilities as appropriate, coordinating with the JV hospice care team.
Provide hospital staff and physicians with education regarding end-of-life care, hospice, and GIP services.
Document activities in the Providence and JV electronic medical records systems and track referral outcomes by nursing unit and JV agency.
Participate in strategic initiatives to support Value-Based Enterprise (VBE) care coordination and discharge planning for post-acute patients.
Attend meetings with hospital service teams, utilization review/discharge planners, and case managers to promote home health and hospice referrals.
Maintain and build relationships with post-acute care providers by serving as a resource for education and information.
Acquire and maintain knowledge of managed care contracts and network provider subcontracts.
Promote and uphold the Patients' Bill of Rights and Responsibilities and follow procedures for documenting and addressing grievances.
LPN/LVN, Registered Dietitian) or a Bachelor's Degree in Social Work.
Master's Degree in Social Work or a Bachelor's Degree in a clinical discipline such as Respiratory Therapy.
Required: At least one year of full‑time clinical experience.
Experience in liaison or care coordination, prior work in the healthcare industry, and familiarity with HomeCare HomeBase and/or Epic EMR systems.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Strong written and verbal communications in English and excellent customer service communication skills by phone, email, and face-to-face.
Ability to articulate and embrace an integrated healthcare at home philosophy, with an understanding of the Value-Based Enterprise agreement between Providence and JV for home health and hospice care coordination. Other Qualifications: Adapting to a dynamic and changing healthcare environment. Building and maintaining positive relationships with hospital and JV staff. Certifications, Licenses, and Registrations

~ Adaptations can be made to accommodate team members with disabilities. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. In a healthcare setting, exposure to bodily fluids, infectious diseases, and conditions typical to the field is expected. Routine use of standard medical equipment and tools associated with clinical care is essential. At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
This position will be covering Santa Rosa Memorial Hospital, Petaluma Valley Hospital and Healdsburg District Hospital. Weekends required.
Compensation Range: $42.12 - $65.40 hourly
Build a Rewarding Career with Compassus At Compassus, we care for our team members as much as we care for our patients and their families. Through our Care for Who I Am culture, we show compassion, respect, and appreciation for every individual. Embark on a career that cares for you while you care for others.
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Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being.
Thrive in a culture where you can be your authentic self, valued for your unique contributions and supported in a community that embraces diversity and inclusion.