This person proactively identifies patients who are appropriate for palliative care and hospice services; assesses all palliative care and hospice referrals based on family patient/family goals to determine appropriate level and type of care for inpatient care or hospice services; provides information to patients/families regarding the palliative care/hospice benefit and ensures continuity of care between settings, physicians, & care team members; participates as a member of the interdisciplinary team; monitors and reports outcomes, assesses/identifies barriers to palliative care and hospice services and works with interdisciplinary team members to address barriers; provides education to physicians, inpatient staff and the community on palliative care, hospice services and end of life care. symptoms and provides education to physicians, inpatient staff, patient caregivers, and the community on palliative care and hospice services, pain and symptom management, and end of life care.