Registered Nurse Navigator - Home Health Review

Role Overview

The RN Navigator Home Health Review monitors home health patients to ensure ongoing eligibility for services according to CMS criteria. They serve as a patient advocate, providing proactive outreach to patients, and collaborate with primary care providers, home health agencies, hospitals, family, and community healthcare providers to coordinate care and facilitate smooth transitions.

• Evaluate Home Health Plans of Care based on Medical Necessity and CMS guidelines.
• Participate in case conferences to assess patient progress and discharge planning.
• Recommend recertification or discharge from services to PCPs.
• Utilize guidelines to optimize care type, frequency, and duration.
• Build positive relationships with healthcare providers and agencies.
• Ensure effective communication across care teams and facilitate care transitions.
• Navigate electronic medical records and care management tools proficiently.
• Monitor program success metrics and identify improvement opportunities.
• Perform outreach focused on medication adherence, self-management, follow-up care, and recognizing worsening conditions.
• Demonstrate a caring, sensitive approach to colleagues and patients, fostering a positive work environment.

• RN license in the applicable state.
• Bachelor’s Degree in Nursing preferred.
• 3-5 years of clinical experience; home health and care management experience preferred.
• Strong communication, collaboration, and care coordination skills.