Registered Nurse Navigator - Home Health Review

About the Role

The RN Navigator Home Health Review is responsible for monitoring home health patients to ensure ongoing eligibility based on CMS criteria. They act as a patient advocate within the care team, providing proactive outreach to value-based payer patients and collaborating with healthcare providers, families, and community resources to coordinate care and facilitate smooth transitions.

Responsibilities

• Assess and evaluate the Plan of Care (Home Health 485 form) for medical necessity and homebound status.
• Facilitate case conferences with Home Health agencies to review patient progress and discharge plans.
• Recommend recertification or discharge to primary care providers based on assessments and guidelines.
• Utilize MCG Guidelines to optimize care type, frequency, and duration.
• Build positive relationships with agencies, clinicians, and staff to ensure effective communication and care continuity.
• Navigate electronic medical records and care management tools efficiently.
• Monitor program success metrics and identify opportunities for improvement.
• Perform outreach focusing on medication adherence, self-management, follow-up care, and early warning signs of deterioration.
• Promote a caring environment by addressing the needs of patients and colleagues.

Requirements

• Bachelor’s Degree in Nursing preferred.
• 3-5 years of clinical experience; 2+ years in home health and care management preferred.
• RN license in the relevant state or compact license required.