RN Case Manager, Utilization Review

RN Case Manager (Home Health Review)

The RN Case Manager (Home Health Review) plays a crucial role in monitoring post-acute patients to ensure they continue to meet the CMS criteria for services. As a key member of the patient's care team, the RN Navigator acts as a patient advocate, providing proactive outreach to post-acute facilities to review patient needs. The Nurse makes recommendations to primary care providers regarding ongoing services and facilitates communication and coordination of care with clinic providers. This role does not involve direct patient care or patient contact. Instead, the nurse works collaboratively with home health agencies to review Plans of Care, ensure recertifications are appropriate, support compliance with Medicare guidelines, and help ensure patients are receiving the right level of care.