Job Description

Company Overview

Select Home Health Services is a leading provider of home health and hospice care, dedicated to delivering personalized support to one patient and one employee at a time. Our mission is to ensure that every individual receives the compassionate care they deserve in the comfort of their own home.

Summary

The Transitions Nurse plays a key clinical role in ensuring patients and families experience a seamless, compassionate entry into hospice care. This position is designed to provide transitional support across multiple functions-including hospice admissions, case management, and transitional care coordination-based on organizational need. The role is expected to evolve into a full-time Transitions Nurse position focused solely on supporting patients through the shift from curative to comfort care.

Responsibilities

• Conduct timely and thorough in-home, facility, or hospital-based assessments to determine hospice eligibility.
• Initiate and coordinate hospice admissions, including completion of required documentation and care plan development.
• Provide skilled nursing care and manage a limited caseload of hospice and/or home health patients as needed.
• Collaborate with physicians and interdisciplinary team members to coordinate patient-centered care.
• Serve as a liaison to referral sources and families to facilitate understanding of hospice services.
• Educate patients, families, and caregivers on the hospice philosophy, clinical expectations, and available support services.
• Support patients and families during emotionally sensitive conversations related to end-of-life care.
• Ensure timely, accurate, and compliant documentation in the electronic medical record.
• Participate in case conferences, care planning meetings, and quality initiatives as required.
• Maintain flexibility to support staffing needs and coverage, including occasional evenings, weekends, or holidays.

Working Conditions

• May involve prolonged periods of sitting, standing, and driving.
• Requires working in patient homes, facilities, and other community settings.
• Flexibility to work evenings, weekends, or holidays as needed to support patient care and transitions.

Requirements

• Current Indiana or Multistate RN license in good standing.
• Minimum of 2 years of clinical nursing experience, with hospice or home health strongly preferred.
• Strong assessment, organizational, and communication skills.
• Ability to work independently while collaborating effectively with interdisciplinary teams.
• Valid driver's license and reliable transportation required for field visits.

Fortis Health and our affiliated companies (Valeo Home Health and Hospice, Select Home Health & Hospice), are an equal employment opportunity agency. Our policy is to hire and promote for all jobs without regard to race, color, religion, national origin, sex, sexual preference, age, marital status, veteran, or physical or mental disability, or any other protected status under applicable laws, unrelated to ability perform the work required. Decisions on employment and promotion are based solely upon an individual's qualifications, with reference to the skills and abilities of the position for which the individual is being considered. If you need assistance or an accommodation due to a disability you may contact is at feedback@fortishh.com

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