Registered Nurse Navigator Home Health Review

Required Education Level: Associate's degree and full Nursys report required with submission- Must be licensed in Texas Registered Nurse Navigator Home Health Review- ONSITE - MUST HAVE HOME HEALTH EXPERIENCE CHRISTUS Irving Corporate Health Plan Administration Office-5101 O'Connor Blvd, Irving, TX 75039

Summary: The RN Navigator 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.

Responsibilities: Meets expectations of the applicable One Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Stays updated on current CMS and other payer guidelines for post-acute Home Health services to ensure compliance. Receives and evaluates post-acute Home Health 485 forms (Plan of Care) based on Medical Necessity guidelines and Homebound Status requirements. Facilitates Case Conferences with post-acute agencies to evaluate patient progress toward goals and discharge plans. Ensures post-acute agencies address the problem list and provide appropriate follow-up for patient needs. Based on CMS or other payer guidelines, patient assessments, and case conferences, makes recommendations to PCPs regarding Home Health recertification or discharge from service. Utilizes MCG Guidelines for post-acute services and Home Care to optimize the type, frequency, and duration of care provided to patients. Creates positive relationships with post-acute agencies, Primary Care Clinicians, and Office Staff to foster collaboration and effective care deliv