Registered Nurse Navigator - Home Health Review

Role Overview

The RN Navigator Home Health Review monitors home health patients to ensure ongoing eligibility for CMS services. They act as a patient advocate within the care team, providing proactive outreach to value-based payer patients and collaborating with healthcare providers to coordinate care and facilitate smooth transitions.

• Evaluate and review Home Health 485 plans of care based on medical necessity and payer guidelines.
• Facilitate case conferences to assess patient progress, discharge planning, and follow-up needs.
• Make recommendations to primary care providers regarding recertification or discharge from home health services.
• Utilize clinical guidelines to optimize care type, frequency, and duration.
• Build positive relationships with home health agencies and clinicians to ensure effective communication and patient care continuity.
• Navigate electronic medical records and care management tools efficiently.
• Monitor program success metrics and identify opportunities for improvement.
• Conduct outreach focusing on medication adherence, self-management, follow-up care, and responding to changes in patient condition.
• Promote a caring environment by actively listening and responding to patient and team needs.

• Bachelor’s Degree in Nursing preferred.
• 3-5 years of clinical experience required; home health and care management experience preferred.
• RN license in the state of employment or a compact license is required.