Registered Nurse Navigator - Home Health Review
Listed on 2026-08-24
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Nursing
Healthcare Nursing, Nurse Practitioner, RN Nurse
Role Overview
The RN Navigator Home Health Review monitors and coordinates care for home health patients to ensure compliance with CMS criteria and other payer guidelines. As a vital member of the care team, they act as a patient advocate, providing proactive outreach and facilitating communication among patients, family, caregivers, physicians, and healthcare providers. They evaluate the Plan of Care, participate in case conferences, and make recommendations to primary care providers regarding recertification or discharge from home health services.
Role OverviewThe RN Navigator Home Health Review monitors and coordinates care for home health patients to ensure compliance with CMS criteria and other payer guidelines. As a vital member of the care team, they act as a patient advocate, providing proactive outreach and facilitating communication among patients, family, caregivers, physicians, and healthcare providers. They evaluate the Plan of Care, participate in case conferences, and make recommendations to primary care providers regarding recertification or discharge from home health services.
Key Responsibilities- Stay updated on CMS and payer guidelines for Home Health services.
- Assess and evaluate the Plan of Care based on medical necessity and Homebound status.
- Facilitate case conferences to review patient progress and discharge planning.
- Ensure follow-up on the problem list and patient needs with home health agencies.
- Utilize clinical guidelines to optimize care plans.
- Build positive relationships with agencies and clinicians to ensure smooth transitions of care.
- Coordinate communication between agencies and primary care practices.
- Navigate electronic medical records and care management tools effectively.
- Monitor program success metrics and identify improvement opportunities.
- Perform outreach focused on medication adherence, self-management, and timely follow-up.
- Promote a caring environment by understanding and responding to patient and team needs.
- Preferred Bachelor’s Degree in Nursing.
- 3-5 years of clinical experience; home health and care management experience preferred.
- RN license in the relevant state or compact license required.
- Strong communication, coordination, and clinical assessment skills.
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