Hospice Hospital Liaison RN - Day Shift (Baraboo)

Location: Baraboo, WI 

Full-time 1.0 (40 hours/week) | Day Shift | Monday-Friday | 8:30am - 5:30pm

Includes weekend (every 4th) and holiday (1-2/year) rotations

Make a lasting impact with Agrace

Join Agrace, a nationally recognized nonprofit leader in hospice and palliative care. If you are a skilled RN who values meaningful, patient-centered care, this is your opportunity to make a difference!

How You’ll Make a Difference (Essential Functions)

The Admissions RN/Hospital Liaison is responsible for admitting patients to Agrace’s homecare program and inpatient units. The Admissions RN/Hospital Liaison is responsible for evaluating patients for appropriate Agrace services; providing patient care; and developing plans of care. In addition, this role is responsible for acting as liaison between Agrace, Hospital Staff and Physician, and Patient and Family, assisting with hospital discharge plans; and developing discharge plans of care. The RN Admissions/Hospital Liaison provides patient and family centered care consistent with Agrace philosophy, goals, standards, regulations and policies.

Key Responsibilities

• Evaluate Patient for Appropriate Agrace Hospice and Palliative programs
  • Review medical records to identify hospice and palliative care services eligibility, physician orders, and to verify diagnosis.
  • Identify if patient meets admission criteria in collaboration with primary care, specialty, and Agrace physicians. Collaborate with IDT and primary care provider to create HES for determination of hospice eligibility.
  • Identify if patient meets admission criteria by assessing patient’s physical, pain, psychosocial, emotional, spiritual, environmental, fall, medication safety, and educational needs. Collect data from the patient, family, significant other and other health care professionals about immediate goals and needs.
  • Serve as a consultant to patients and families about end-of-life issues and Agrace programs philosophies and services.
  • Collaborate with CTM regarding all patients deemed ineligible for hospice services.
• Act as Liaison between Agrace, Hospital Staff and Physician, and Patient and Family
• Serve as a resource and consultant for hospital/clinic staff, physicians, nurses, social workers, chaplains about pain, symptom management, end-of-life issues, hospice/palliative care philosophies and services.
• Serve as a consultant to patients and families about end-of-life issues and Agrace philosophies and services.
• Actively pursue relationships and develop partnerships with all referral sources to promote the benefits of Agrace services.
• Patient Care
  • Provide interventions, treatments, and symptom management to patient and family to meet immediate needs. Evaluate the effectiveness of symptom management or other intervention and adjust to meet needs.
  • Provide patient and family education on pain, symptom management, end of life, etc. Evaluate the effectiveness of education and adjust to meet needs.
  • Review advanced directives and obtain required Agrace paperwork including informed consent; service agreement; and Hospice benefit election form.
• Plan of Care (POC) and Discharge Planning
  • Formulate and implement an individualized POC in collaboration with nursing facility, patient and family.
  • The POC will include goals, symptom management, interventions, education, discharge plan, coroner involvement.
  • Identify potential care challenges and document in the POC interventions to minimize, manage, or resolve the concern.
  • Obtain medication and other orders.
  • Order durable medical equipment.
  • Review advanced directives and obtain required Agrace paperwork including informed consent; service agreement; and Hospice Benefit Election form.
• Miscellaneous
  • Pr