Role Overview: The RN Navigator Home Health Review monitors home health patients to ensure ongoing eligibility for CMS services.

Key Responsibilities:

• Evaluate and oversee patient care plans based on Medical Necessity and CMS guidelines.
• Facilitate case conferences with home health agencies to assess patient progress and discharge planning.
• Recommend recertification or discharge to primary care providers.
• Coordinate communication among healthcare providers, agencies, and patients to ensure seamless care transitions.
• Support transitions of care through outreach focused on medication adherence, self-management, and follow-up.
• Utilize electronic medical records and care management tools effectively.
• Monitor program success metrics and identify opportunities for improvement.
• Promote a positive, patient-centered work environment.
• Perform additional duties as assigned.

Qualifications & Skills:

• RN license in the relevant state.
• 3-5 years of clinical experience, with preferred home health and care management experience.
• Bachelor’s Degree in Nursing preferred.
• Strong communication, coordination, and documentation skills.
• Knowledge of CMS, payer guidelines, and care management protocols.