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. Key Responsibilities 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. Qualifications & Skills 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. #J-18808-Ljbffr Live Well Homecare