Maintains knowledge of inpatient plan of care and continues to coordinate transplant or VAD care, as appropriate, Provides post transplant or post implant education to patient and caregiver, Collaborates with multidisciplinary team and patient for discharge planning, Identifies and responds to physical, psychosocial, and educational needs of patient and caregiver, Collaborates with members of the multidisciplinary team, Reinforces education and post transplant or post implant care and compliance, Ensures post transplant or post implant testing, care, and visits are scheduled in a timely manner, Follows up on results of testing, Administrative, research, and other duties, Able to provide in service training to various groups such as, patients, community groups, and staff, Maintains current knowledge of clinical and regulatory requirements for transplant and VAD, Works to obtain or maintain CCTC, Reviews and shares literature to support evidence based practice, Participates in QAPI, Provides input to clinical protocols and program guidelines, Supports the program research activities and understands limits of participation in research if not CITI trained, Promotes positive relationships with referring physicians, Maintains and submits monthly time studies, On Call. Facilitates the evaluation of heart transplant candidates beginning with the transplant evaluation consent, Arranges interfacility transfer when necessary, including informing financial coordinator and clinical nurse manager prior to transfer, Assesses patient and caregiver level of understanding of heart failure and transplant, and provides continuous education of the disease process, treatments, evaluation process and requirements, transplant surgery, medications, waitlisting, and follow up requirements, Provides clinical expertise in the coordination of care and resources to meet the needs of heart failure or transplant patients, Monitors test results and coordinates follow up, Facilitates rapid completion of transplant evaluation and case presentation at weekly multidisciplinary team meeting, Maintains communication with patient, referring physicians, transplant team, and other healthcare providers, as appropriate, Provides required information to UNOS, NJ Sharing Network, Intermacs, VAD Connect, and other databases, as required, Heart Failure/VAD.