Role Overview:

The RN Navigator Home Health Review is responsible for monitoring home health patients to ensure they meet CMS criteria for continued services. As an integral part of the care team, they act as a patient advocate, providing proactive outreach to value-based payer patients, and collaborating with primary care providers, specialists, and community healthcare providers to facilitate seamless care transitions.

Key Responsibilities:

Evaluate and interpret Home Health 485 forms based on medical necessity and CMS guidelines. Facilitate case conferences to assess patient progress and develop discharge or recertification plans. Recommend appropriate care adjustments to PCPs based on assessments and guidelines. Coordinate communication among home health agencies, providers, and patients to ensure needs are met. Support transitions of care, including medication reconciliation, patient education, and follow-up planning. Utilize electronic medical records and care management tools effectively. Monitor program success metrics and identify improvement opportunities. Promote a caring and responsive work environment by understanding patient and team needs.

Qualifications & Skills:

Bachelor's Degree in Nursing preferred. 3-5 years of clinical experience; home health and care management experience preferred. RN license required in the state of employment or compact license. Strong knowledge of CMS and payer guidelines, and proficiency with electronic medical records.