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 according to CMS criteria. They act as a patient advocate within the care team, providing proactive outreach to value-based payer patients and supporting care transitions.

Responsibilities

• Evaluate Plan of Care (Home Health 485 form) for medical necessity and patient status.
• Facilitate case conferences with home health agencies to assess patient progress and discharge planning.
• Make recommendations to primary care providers regarding recertification or discharge based on guidelines and assessments.
• Coordinate communication among healthcare providers, agencies, and families to ensure seamless care transitions.
• Utilize electronic medical records and care management tools effectively.
• Monitor program success metrics and identify improvement opportunities.
• Perform outreach focused on medication adherence, self-management, follow-up care, and early warning signs.
• Promote a positive, caring work environment by addressing the needs of patients and colleagues.
• Support discharge processes and documentation in accordance with CMS and population health workflows.

Requirements

• RN license in the appropriate state or compact license.
• Bachelor’s Degree in Nursing preferred.
• 3-5 years of clinical experience; home health and care management experience preferred.
• Strong knowledge of CMS guidelines, electronic health records, and care management applications.
• Excellent communication, coordination, and interpersonal skills.