Inspire health. Serve with compassion. Be the difference. Job Summary To coordinate internal referrals and intake procession of patient’s being referred from institutional facilities and clinics. Acts as a liaison between hospitals, medical offices, home health agencies, and medical suppliers. Accountabilities Assessment: Collects and submits patient data to be evaluated for appropriateness of homecare services. Completes required forms and documents per agency/hospital policy and procedures. 10% Referral and Intake: Keeps Homecare staff informed of possible referrals from hospital. Accurately accepts patient referrals and manages those referrals through the appropriate home care service line process. Provides comprehensive communication to family, patients, hospital case management, physicians and providers, home care leadership, home care clinicians and other members of the care team such as pharmacies and DMEs to ensure the patient is properly navigated through the referral and intake process. 10% Initiates appropriate referrals and specialty services. Communicates and implements change appropriately. Presents home health, hospice, hospital at home, monitored at home services to family members, patients, case management, and providers. Communicates and implements change appropriately. Explains homecare services to patient/family/caregiver including admission criteria. 10% Completes intake accurately and properly to ensure seamless discharge from facility or hospital and admission to home care service. 10% Ongoing communication with hospital case management and other case management services, attending providers, and clinical staff to facilitate continuity of care. Communicates with staff involved in patient’s care (may include physician, social worker, nurse, therapist.) Acts as an educational resource for other team members. Acts as a liaison with physicians, hospital, insurance, medical equipment companies and clinical areas. 10% Demonstrates active participation as a liaison with physician’s office, hospital and medical support services. Assists with orientation and training seminars for agency staff and community education programs. Endeavors to work well with team members and hospital staff. Complies with hospital and agency policies addressing safe working condition, recognizes inappropriate patient care referrals and refers to immediate supervisor. Completes tasks specified as leadership role responsibilities with appropriate documentation. 10% May conducts various types of telehealth visits in home care services. Triages and facilitates calls to appropriate discipline. Schedules F2F clinician visits, attending physician visits and admissions, coordinating visits with regulatory requirements, IDG, ensures visits are conducted at proper intervals per home care service line. Assists with IDG prep, case conference prep, patient discharge and record closure. 10% Completes QA audits as requested. 10% Supports assistant managers, RNs, CNAs, and office staff. 10% Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Education Graduate of an accredited school of nursing. Minimum Experience 1 year experience in Home Care Required Certifications/Registrations/Licenses Licensed to practice as a LPN or RN in South Carolina Driving Requirements If driving is required for the position, must provide a valid driver’s license, a certificate of auto insurance and have an acceptable motor vehicle record as defined by the Acceptable Motor Vehicle Record (MVR) Chart. Work Shift Day (United States of America) Location Home Health Roper MT Facility 1067 Hospice - Upstate Department 12029035 Administrative and General Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health. Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family. Our promise is to: Inspire health. Serve with compassion. Be the difference.