• Manage Journey patient census and referrals for the assigned area from the Journey candidate list, the Journey Administrative Assistant, Customer Service, Clinicians, and other sources
• Review all assigned patient charts to determine eligibility and appropriateness for the Hospice benefit and prepare for conversations with the patient, family, and/or caregivers
• Make initial phone calls to all new Journey referrals to schedule home visits, as well as follow-up calls to maintain contact with the patient and assess patient decline
• Conduct patient visits for building a relationship with the patient and/or family, and in-depth discussion of the hospice benefit when appropriate
• Maintain Journey patient charts, documenting all Journey visits and contacts in Journey Visit/Phone call notes or as Coordination notes when applicable
• Build relationships with and maintain effective communication with Clinicians to ensure effective collaboration for addressing patient needs
• Ensure that Journey charts are created and maintained for each Journey patient
• Meet and exceed if possible, expectations for weekly patient visits, weekly patient phone calls, and monthly transitions to hospice care
• Assist clinicians in a more accurate understanding of the philosophy, goals, eligibility, and benefits of Hospice care
• Assist the Hospice and/or Home Health team in efficient transitions to Hospice in whatever capacity may be needed, whether in extra visits, calls, paperwork, or any other task