Physical Requirements: OCCASIONALLY: Bend/twist, Biohazard waste, Blood and/or Bodily Fluids, Chemicals/Medications, Climb stairs/ladder, Cold Temperatures, Color vision, Communicable Diseases and/or Pathogens, Flexing/extending of neck, Fume /Gases /Vapors, Hand use: grasping, gripping, turning, Hot Temperatures, Lifting / Carrying: 0-10 lbs, Lifting / Carrying: 11-20 lbs, Lifting / Carrying: 21-40 lbs, Lifting / Carrying: 41-60 lbs, Loud Noises, Machinery, Patient Equipment, Pushing / Pulling: 0-25 lbs, Pushing / Pulling: 26-40 lbs, Pushing / Pulling: 41-60 lbs, Reaching above shoulder, Squat/kneel, Working at Heights, Working Outdoors. Job Description: Essential Functions: Actively collaborates with the attending practitioner, the family and other members of the multidisciplinary team to coordinate an individualized plan of care across the continuum, communicates the plan to key stakeholders and facilitates a safe and timely discharge to the next level of care.