Job Summary
The Clinical Liaison supports continuity of care between Heartlinks’ programs, internal education and support efforts, along with community engagement for hospice and palliative care services in accordance with the Medicare Hospice Conditions of Participation, Washington State regulations, and Heartlinks organizational policy. This role serves as a liaison between departments, patients, families, facilities, vendors, staff, and community partners by providing education, outreach, follow-up after discharge, volunteer support, and onboarding education to promote understanding of hospice philosophy and smooth transitions across programs and care settings.
Essential Job Functions / Responsibilities
Transitions of Care & Interdisciplinary Support
(40% - 20% Hospice / 10% Palliative Care / 5% Health Homes / 5% Adult Family Home)
- Assists with intakes, informational visits, and pre-admission education as assigned, providing non-clinical support and coordination with admissions and clinical staff.
- Provides education and support to patients transitioning between organizational programs (e.g., palliative care, hospice, health homes, pediatric services, bereavement, community services).
- Serves as a resource for patients and families during transitions to reduce gaps in services and improve continuity of care.
- Collaborates with clinical staff, admissions, social services, volunteer services, and leadership to support smooth transitions and consistent messaging.
- Monitors and follows up with patients and families after discharge from hospice or palliative services to ensure understanding of ongoing plan of care, available resources, and next steps, and coordination of care.
- Communicates transition-related concerns to appropriate clinical and administrative leadership.
- Participates in Quality Assessment and Performance Improvement (QAPI) activities related to transitional care monitoring, outreach and education.
- Maintains strict confidentiality in compliance with HIPAA, Medicare CoPs, and Washington State privacy regulations.
- Performs other duties as assigned to support organizational mission and regulatory compliance.
Education and Outreach
(45% - 40% Hospice / 5% Palliative Care)
- Community Services (20% of Hospice / 5% Palliative Care)
- Provides ongoing education and support to partnered facilities, referral sources, and vendors regarding hospice philosophy, eligibility, services, and organizational processes.
- Maintains positive working relationships with community partners to support patient access and continuity of care.
- Participates in outreach activities, marketing initiatives, in-services, and community education events.
- Promotes, strengthens, and expands bereavement and community support services through outreach and community engagement efforts.
- Implements strategies to increase the reach and utilization of community support programs throughout the service area.
- Staff, Volunteer & Organizational Education (20%)
- Provides high level education to staff and volunteers related to all areas of hospice philosophy, communication, boundaries, grief awareness, transitions of care, community resources, stress reduction, and best practices, etc.
- Assists with the supervision and field support of hospice volunteers, including assisting with educational sessions.
- Provides hospice philosophy education to all new hires, including orientation support and reinforcement of mission, values, and scope of services.
- Assists with the onboarding of non-clinical staff, including training coordination, education tracking, and initial role support.
- Provide collaboration and consultation with members of the MSW team for high acuity or difficult patient cases.
- Participate and manage ongoing support for organizational committees including Social Justice and Equity Committee and the Outreach Committee.
- Monitor and maintain all records of internal and external education including participants, hours, topics, etc.
Caseload Management
(15% - 10 % Hospice / 5% Palliative Care)
- Expected to manage a dynamic caseload of 10-15 hospice and palliative care patients based on other duties including: transition follow-ups, outreach accounts, facilities or volunteer education, onboarding schedules and additional responsibilities across multiple programs.
- Assist with PRN visits or admissions as needed based on community and organizational need.
Position Qualifications:
- Bachelor’s degree in Social Work, Human Services, Healthcare Administration, Education, or related field required; Master’s degree preferred.
- Minimum of one (1) year of experience in hospice, palliative care, healthcare, outreach, case management, or community education preferred.
- Knowledge of hospice philosophy, transitions of care, community resources, and end-of-life services strongly preferred.
- Strong verbal, written, presentation, and organizational skills.
- Ability to work independently, manage multiple priorities, and collaborate effectively with interdisciplinary teams.
- Comfort with community education, public speaking, and relationship-building.
- Current CPR certification required per organizational policy.
- Must possess a valid Washington State driver’s license, reliable insured vehicle, and ability to travel within the service area.
Benefits:
- Full-time employees accrue up to 168 hours of PTO annually, in addition to sick time accrued at the rate of 1 hour for every 40 hours worked. Bereavement and jury duty leave are also available.
- Option to enroll in medical, dental, vision, and life insurance. Heartlinks pays for 100% of the employee's medical premiums and 75% of the employee's dental and vision premiums. Health benefits begin the first of the month after the start date.
- Miles driven for work are reimbursed.
- Holiday pay for 6 observed holidays.
- Ability to enroll in 401(k) and begin contributing at the time of hire. Heartlinks will match dollar for dollar up to 5% of earnings after one year of employment and 1080 hours worked.
- Tuition reimbursement/professional development assistance.
- Premium pay for hospice-related certifications.
- Wage dependent on hospice experience.