Registered Nurse Navigator - Home Health Review

About the role

The RN Navigator Home Health Review monitors home health patients to ensure ongoing eligibility for services, acting as a patient advocate within the care team.

Responsibilities

• Evaluate and review CMS and payer guidelines for home health services.
• Assess Plan of Care (Home Health 485 form) based on medical necessity and homebound status.
• Facilitate case conferences with home health agencies to evaluate patient progress and discharge planning.
• Make recommendations to primary care providers regarding recertification or discharge.
• Use MCG Guidelines to optimize care type, frequency, and duration.
• Build positive relationships with home health agencies, clinicians, and staff.
• Coordinate care transitions and ensure clear communication among providers.
• Navigate electronic medical records and care management tools effectively.
• Monitor program success metrics and suggest improvements.
• Conduct outreach focusing on medication adherence, self-management, follow-up, and early warning signs.
• Support discharge processes, documentation, and population health workflows.
• Promote a caring, collaborative work environment.

Requirements

• Bachelor’s Degree in Nursing preferred.
• 3-5 years of clinical experience, with 2+ years in home health preferred.
• Managed care or care management experience is advantageous.
• RN license in the state of employment or a compact license is required.

Schedule

Full-time role, working five days a week, eight hours per day.