Hospital Liaison.

Description

Coordinates services of hospital / emergency room follow-up care. Provides assessment, planning, coordination, and advocacy services for patients. Provides non-clinical educational information, wellness programs and organizes related services for the patient while in the clinic or community setting. Familiar with all programs to provide office support and continuity of care for various patient populations.

Primary Functions :

• Coordinates hospital and emergency department follow up care.
• Serves as a liaison between VNA inpatients at the hospital and the VNA clinic to coordinate patient primary care services.
• Face to face patient contact at hospitals, clinics and patient homes as indicated.
• Communicates with hospitals and on-call staff to track patient hospitalization, status and discharge information.
• Participates in hospital “care team” meetings to present VNA information regarding services, health plan participation and program updates.
• Meets all VNA and hospital credentialing criteria for hospital rounding.
• Rounds on all postpartum / newborn and hospital inpatients daily, or as indicated and prepares parents of newborns for child's first appointment.
• Coordinate clinic follow up appointments for patients by ensuring appointments at the clinic are made prior to discharge from the hospital, if possible.
• Ensure discharge summary, test results, etc. are available for providers at follow up appointments.
• Inform patient of available resources and assist the patient in making appointments as needed.