Coordinate care and visit utilization among interdisciplinary team members, including Skilled Nursing (SN), Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Medical Social Work (MSW), and Home Health Aides (HHA), while coordinating the plan of care with the physician. The Occupational Therapist collaborates with physicians, patients, caregivers, and the interdisciplinary team to address physical, psychosocial, and cognitive impairments while supporting quality outcomes throughout the home health episode and discharge process.