Care Transitions Specialist na Home Healthcare and Hospice Community Services

At Home Healthcare, Hospice and Community Services, our mission is to provide compassionate, dignified end-of-life care that supports patients and families physically, emotionally, and spiritually. As a leading hospice care provider, we are committed to honoring every person’s journey with respect, comfort, and understanding. We are currently seeking a dedicated Care Transitions Specialist to serve as a vital link between healthcare facilities, providers, and our hospice team to ensure seamless transitions into hospice care.

The Care Transitions Specialist is responsible for facilitating timely hospice admissions, educating patients and families about hospice benefits, and building strong relationships with referral sources to promote access to care.

 Key Responsibilities:

• Collaborate with hospitals, skilled nursing facilities, physicians, and care coordinators to identify patients appropriate for hospice care.
• Serve as a liaison between referral sources and the hospice admissions team to ensure timely and appropriate transitions.
• Educate patients, families, and caregivers on the philosophy, services, and eligibility requirements of hospice care.
• Assess patient needs and coordinate with clinical and administrative staff to support a smooth admission process.
• Facilitate communication among all parties involved in the patient’s care to promote understanding and continuity.
• Develop and maintain positive relationships with referral partners through regular visits, in-services, and responsive communication.
• Maintain accurate and timely documentation in accordance with agency policy and regulatory guidelines.
• Participate in community outreach and marketing activities to promote hospice awareness and access.

Why join us?

• Competitive salary 
• Comprehensive health, dental, and vision insurance
• Paid time off, holidays, and bereavement leave
• Continuing education and professional development
• 403(b) with employer match
• Mileage reimbursement 
• Supportive, mission-driven work environment

• Licensed RN, LPN, or Social Worker; OR 
• Three (3) years of satisfactory experience in community health in a licensed and/or Medicare Certified Program. Recent acute hospital experience and supervisory experience; OR
• A combination of education and experience determined to be equivalent to the above-listed education and experience      requirements.
• Possession of a current State of New Hampshire license to practice as a Registered Maintain current cardiopulmonary      resuscitation (CPR) certification.
• Valid driver’s license. Have access to an automobile during working hours that meets the State of New Hampshire registration      regulations and auto liability insurance.
• Must be able and willing to learn to utilize a portable electronic field device. Must be able to manage electronic patient health information (ePHI) remote access in accordance with HCS policies and procedures.