Registered Nurse Navigator - Home Health Review

Role Overview

The RN Navigator Home Health Review is responsible for monitoring home health patients to ensure ongoing eligibility for CMS services. They act as a patient advocate within the care team, facilitating communication among physicians, clinics, hospitals, families, and community providers. The role involves supporting care transitions, evaluating the Plan of Care, and making recommendations for recertification or discharge based on CMS guidelines.

Key Responsibilities

• Stay current with CMS and payer guidelines for home health services.
• Evaluate the Home Health 485 form for medical necessity and patient status.
• Lead case conferences to assess patient progress and discharge planning.
• Ensure follow-up and addressing of patient issues with home health agencies.
• Collaborate with primary care providers, agencies, and team members to optimize care and ensure smooth transitions.
• Utilize electronic health records effectively and monitor program success metrics.
• Perform outreach focused on medication adherence, self-management, and timely follow-up.
• Foster positive relationships with healthcare providers and team members.

Qualifications & Skills

• Bachelor's degree in Nursing preferred.
• 3-5 years of clinical experience, with 2+ years in home health and/or care management preferred.
• RN licensure in the state of practice required.
• Proficiency in care management applications and electronic medical records.
• Strong communication, collaboration, and patient advocacy skills.