Explore opportunities with Christus Home Care, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. Primary Responsibilities Educate patients on post-discharge follow-up, homebound criteria, and obtaining prescriptions Assess readmission risk using the LACE tool Ensure patients and families have agency contact information Coordinate ancillary services (DME, Infusion) as needed Assist in preparing for patient care post-discharge Liaise between the agency and healthcare providers Communicate patient transfers and coordinate resumption of care Provide feedback on readmissions and non-admit decisions Per...