Registered Nurse

Registered Nurse Navigator - Home Health Review

We are seeking an experienced Registered Nurse Navigator – Home Health Review to support post-acute care management and ensure patients receiving home health services continue to meet CMS and payer requirements.

This role will serve as a liaison between home health agencies, providers, and care teams to coordinate appropriate care, maintain regulatory compliance, and support positive patient outcomes.

Key Responsibilities:

• Review Home Health Plan of Care (485) forms for medical necessity and homebound status compliance.
• Monitor patients receiving post-acute/home health services.
• Collaborate with home health agencies, physicians, and care teams regarding patient progress and ongoing care needs.
• Participate in case conferences and support discharge planning activities.
• Make recommendations regarding home health recertification or discharge based on clinical and payer guidelines.
• Utilize MCG and CMS guidelines to evaluate appropriate levels of care.
• Facilitate effective communication and coordination among providers, home health agencies, and care teams.
• Ensure compliance with applicable regulatory, CMS, and payer requirements.
• Maintain accurate clinical documentation and records.

Required Qualifications:

• Associate Degree in Nursing (ADN) required.
• Active Texas Registered Nurse (RN) license required.
• Recent Home Health experience required.
• Strong knowledge of CMS guidelines, home health regulations, and care coordination processes.
• Strong clinical assessment, communication, organization, and critical-thinking skills.
• Experience reviewing Home Health Plan of Care (485) documentation preferred.

If you are interested in this opportunity, please apply with your updated resume or reach out to me directly.