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, acting as a patient advocate within the care team. Key Responsibilities Evaluate and review the Home Health Plan of Care based on medical necessity and CMS guidelines, facilitate case conferences with agencies, and coordinate communication among providers, patients, and caregivers. Make recommendations to primary care providers regarding recertification or discharge, ensuring smooth care transitions and optimal care plans using guidelines like MCG. Maintain positive relationships with agencies and clinicians, monitor program success metrics, and perform outreach focusing on medication adherence, self-management, and timely follow-up. Ensure effective documentation and navigation of electronic records, promote a caring approach, and support discharge processes in compliance with CMS and population health workflows. Qualifications & Skills Bachelor's degree in Nursing preferred; 3-5 years of clinical experience required, with 2+ years in home health and care management preferred. Must hold an RN license valid in the state or a compact license. Demonstrates strong communication, coordination, and care management skills, with proficiency in electronic medical records and care guidelines. #J-18808-Ljbffr Vetted Solutions