Care Transition Coordinator- Hospice

We are hiring for a Care Transition Coordinator– RN/LPN or MSW with Hospice Experience.

At Christus Hospice in Corpus Christi, TX, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve—it truly is all about helping people. You can find a home for your career here.  ​ 

As a Care Transition Coordinator, you can expect: 

• ​the ability to develop trusting relationships as an end-of-life care expert. 
• being valued and respected by patients and their families.
• employee-focused wellness and support programs 
• incredible team support and empathetic leadership

Take your nursing career to a new level of caring. Join us. 

*Responsibilities for Internal Candidates 

The Care Transition Coordinator’s primary responsibility is to facilitate a seamless transition for patients
discharging from a facility setting to the care of an LHC Group hospice agency. 

• Responsible for achievement of admission goals expectations as established at hire or at review of annual agency budget goals.
• Assists the LHC Group agency with preparing for and accepting care of the patient post-discharge.
• Assists the Administrator with execution of contracts for facility-based services for hospice patients.
• Explains hospice services and agency procedures to the patient and their family members.
• Involves the family and caregivers in the educational process and assesses post-discharge educational coaching needs.
• Participate in bi-weekly IDG meetings, as necessary to give an update regarding accounts, customer needs, and progress towards agency growth strategies.

• Successfully executes a weekly, monthly, and quarterly strategy to increase market share through key account development including prospecting diversification and call frequency routing. Plans activity to maximize territory coverage of both existing and prospective accounts
• Responsible for achievement of admission goals|expectations as established at hire or at review of annual agencybudget goals.
• Assists the LHC Group agency with the preparation for accepting care of the patient post discharge from thehospital.
• Coordinates other services for the patient with ancillary service providers (DME|Infusion).
• Coordinates the gathering, organization and transfer of necessary information to the applicable LHC Groupagency staff.
• Ensures the availability of a attending physician to follow the patients care in the home or the transfer of primary care to the hospice medical director.
• Assists the Administrator with execution of contracts for facility based services for hospice patients.
• Explains hospice services and agency procedures to the patient and his|her family members.
• Involves the family|caregivers in the educational process and assesses post-discharge educational|coachingneeds.
• Knowledgeable about state specific admission criteria and timelines for admission.
• Monitors the status of all patients receiving Respite or General Inpatient Care and facilitate thecommunication between the agency|hospital|physician.
• Participate in bi-weekly IDG meetings, as necessary to give an update regarding accounts, customer needs, and progress towards agency growth strategies
• Participates in weekly one-on-one meetings with Administrator
• Responsible for the initial medication reconciliation with appropriate hand off and communication to visiting staff.
• Schedules a follow-up phone call to the FCC in the system 48 hours post admit.
• Serves as a liaison between the LHC Group agency, the facility care setting and the referring physician
• Serves as an educational resource for hospital staff and physicians regarding the hospice benefit and relatedregulations, including, consulting with hospital staff or physicians regarding an individual patients suitability forhospice benefit provided there is NO contact with the patient or the patients family members prior to the referral tohospice
• Visits and communicates with the patient in the hospital to obtain necessary information to facilitate the transfer.
• All other duties as assigned.

• Must have one year hospice experience or one year of hospital case management experience.
• Must have current Registered Nurse (RN) or Licensed Practical Nurse (LPN) or Social Worker (SW) licensure in state of practice.
• Excellent organizational skills.
• Excellent verbal and written communication skills.
• Must have thorough understanding of hospice qualifying criteria and coverage guidelines.
• Proficient computer skills.
• Current CPR, driver's license, valid vehicle insurance and access to a dependable vehicle, or public transportation.