RN Hospice Care Navigator

Cleveland Clinic; Independence Township (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

Cleveland Clinic’s Hospice Coordinator role supports the Home Care and Hospice operations, coordinating inpatient referrals, discharge plans, and services for patients in their homes. The position works with an interdisciplinary team to ensure smooth transitions from hospital to community settings and to educate families about hospice benefits.

The role requires an RN license, 1+ year of acute care experience, and ability to travel to hospitals and referral sources.

Qualifications

• Graduate from an accredited school of Professional Nursing.
• Current state licensure as a Registered Nurse (RN).
• One year of current clinic experience as an RN.
• One year of experience in an acute med/surg or critical care setting.
• Basic Life Support (BLS) Certification through the American Heart Association or the American Red Cross.
• Knowledge of JCAHO and Medicare standards and regulations.
• Ability to work irregular/varying hours as needed.
• Ability to travel to hospitals and community referral sources.

Responsibilities

• Act as a member of the interdisciplinary team for the assigned functions related to the coordination of services with internal and external referral sources.
• Process inpatient referrals into hospice, ensure continuity of care and coordinate discharge planning in contract facilities.
• Actively educate potential customers about the benefits and appropriateness of hospice care.
• Ensure patients and their families have adequate knowledge and an understanding of the hospice benefit.
• Process inquiries for all new referrals (internal and external).
• Ensure a seamless transition from hospital to the community setting by ordering medical supplies and DME, handing off communication with the field team and documenting in the electronic medical record.
• Perform assessment of potential patients consistent with Cleveland Clinic Hospice policies, procedures and admission criteria alongside the physician.
• Perform admission assessments for new admissions into contracted facilities and document information in the EMR within specified time frame.
• Plan the delivery of patient care in collaboration with other disciplines to provide comfort and symptom management.
• Perform daily assessment and coordinate the plan of care with inpatient staff for General Inpatients (GIP).
• Assess patient for safety risks, abuse and neglect.
• Assess and document pain using the appropriate pain scale and manage patient’s pain.
• Document changes in patient condition and effectiveness/timeliness of care/interventions.
• Evaluate, update and revise the plan of care to facilitate achievement of expected outcomes.
• Know action, usual dosage, indications and side effects of medications administered.
• Attend interdisciplinary meetings as assigned.

Skills

RN licensure

Travel to hospitals

Coordination

Interdisciplinary team

Education

Registered Nurse degree

BSN (preferred)

Tools

EMR navigation

Job description

Cleveland Clinic’s Hospice Coordinator role supports the Home Care and Hospice operations, coordinating inpatient referrals, discharge plans, and services for patients in their homes. The position works with an interdisciplinary team to ensure smooth transitions from hospital to community settings and to educate families about hospice benefits.

The role requires an RN license, 1+ year of acute care experience, and ability to travel to hospitals and referral sources.