Description

Evaluates patients referred to the Organization; identifies insurance coverage, plans, and coordinates referrals for hospice care services. Provides General Inpatient (GIP) Start of Care and daily visits for Torrance Memorial Medical Center's GIP patients

Core Competencies

Responds to referrals for hospitalized patients referred for hospice care. Assesses documentation of care according to specific guidelines thereby promoting consistency in methodology and validity of the resulting data. Identifies insurance overage of hospice care services. Consults with physicians, nurses, social workers, discharge planners and other disciplines to assist in establishing a coordinated hospital discharge to hospice services Demonstrates the ability to conduct thorough, person-centered interviews with patients, families, and caregivers to gather essential information about the home environment, current needs, and non-clinical factors that influence the plan of care. Completes referral information that includes intake data, essential background information, hospital course, and the plan of care Maintains liaison relationship with hospital and insurance personnel, providing information and education on hospice services, coverage issues and related areas Collects and maintains statistical data on all referrals and submits them regularly as required. Works with other health care clinicians in the development of safe care transition from hospital to community. Communicates with the appropriate interdisciplinary team members any changes in patient's condition or psychosocial status and coordinates changes in support and services to provide maximum comfort and maintain quality of life. Complies with all Medicare regulations governing Hospice.