Job Summary
The Family Support Services Coordinator provides coordination and operational support across Community-Based Hospice, Bereavement Services, and Care Navigation. Working from needs identified by clinical staff, this role supports patients and families through transitions in care and services by coordinating transportation, facilitating community respite and placement processes, assisting with bereavement service enrollment and workflows, tracking Care Navigation data points, and supporting departmental operations.
Working collaboratively with patients, families, interdisciplinary teams, vendors, and community partners, this position serves as a compassionate and reliable point of connection, fostering positive relationships, representing the organization professionally, and helps ensure a seamless experience across services and transitions of care.
The schedule for this position is Monday-Friday 8:30am-5:00pm; One major or two minor holidays per year.
Responsibilities (What you do)
Care Transitions & Placement Support
- Serve as the primary contact for transportation coordination for established community-based hospice patients in a home or facility setting, excluding transportation needs associated with admissions or hospital-based patients.
- Arrange timely transportation using information provided by field staff; coordinate with patients, families, transportation providers, facilities, and team members. Communicate with families with empathy, clear timelines, and a reassuring tone during high-stress transitions.
- Support placement processes by initiating PASARR and FL-2 forms, completing non-clinical sections, and coordinating seamless handoff to clinical staff for required clinical documentation.
- Serve as a positive representative of Transitions LifeCare when interacting with facilities, capturing operational or staffing updates on Facility Resource Sheets
- Collaborate with team members and leaders to address barriers to care transitions.
- Demonstrate knowledge of payor source considerations, ensuring required approvals, and documentation are obtained in accordance with organizational and regulatory standards.
- Assist with other transition-related coordination activities as organizational needs evolve.
Bereavement Program Support
- Support bereavement program workflows and care plan management activities.
- Open bereavement plans of care based on the social worker’ documented assessment. Enter service intervention dates to automate call outreach tracking lists and care note mailings.
- Monitor bereavement documentation timelines and communicate follow-up needs to appropriate team members.
- Support bereavement outreach efforts, special projects, and program initiatives.
- Assist the bereavement Department with logistical and administrative tasks that support bereavement events, educational programs, and community outreach activities as needed.
- Collaborate with bereavement clinicians and leadership to support efficient program operations.
Care Navigation & Departmental Support
- Provide operational support to Care Navigation including phone calls to patients and caregivers
- Collect and track outcomes, and assist with maintaining accurate spreadsheets for data analysis
- Maintain a working knowledge of Transitions Lifecare service lines to complete informational visits.
- Meet with Vendors and update vendor resource list.
- Proactively notify leadership of workflow challenges, or systemic barriers identified to support continuous quality improvement.
- Perform other duties as assigned by the supervisor.
Expectations (How you do it)
- Approach every family, caller, and partner with authentic warmth, patience, and active listening, recognizing that families navigating end of life and care decisions are often under emotional stress.
- Represent Transitions LifeCare with diplomacy, poise, and professionalism to cultivate strong, collaborative relationships with partner facilities, transport vendors, and community providers.
- Maintain close alignment and responsive communication with field social workers, nurses, PCCs, and leadership to ensure seamless end-to-end care coordination.
- Manage competing coordination priorities with sound judgment, steady focus, and meticulous follow-through. Identify and report operational risks or documentation delays to leadership promptly.
- Protect confidentiality and exercise discretion with sensitive information.
- Maintain high productivity, self-motivation, and responsive communication while working remotely.
- Follow TL policies and procedures, applicable ACHC Standards and Medicare Conditions of Participation, and relevant laws, regulations, and professional standards within the role’s scope.
- Promptly report concerns, issues, or risks to the immediate supervisor or management team.
- Support agency-wide diversity, equity, and inclusion efforts and maintain the schedule established in the Employee Information Agreement.
Requirements (What you need)
- Bachelor's degree in Social Work, Human Services, Psychology, Healthcare Administration, Gerontology, Counseling, or a related field; equivalent experience in healthcare coordination or customer relations will be considered.
- At least three years experience in healthcare, hospice, care coordination, social services, or high-touch family relations. Experience working with patients, families, older adults and knowledge of hospice philosophy and end-of-life care is strongly preferred.
- Emotional intelligence, communication skills (verbal and written) and the ability to speak calmly and reassuringly to distressed individuals.
- Valid driver's license, reliable transportation, and willingness to travel periodically within our service area as required.
- Proficiency in electronic medical record (EMR) data entry, Microsoft Office applications (Word, Excel, Outlook), and remote collaboration tools.
- Strong organizational, time-management, critical-thinking, and problem-solving skills.
- May be required to lift and/or carry items up to 25 pounds.
- Strong attention to detail, time management, and ability to work independently in a hybrid remote environment while adhering to scheduling requirements.