About the role
Role Overview The RN Navigator Home Health Review is responsible for monitoring home health patients to ensure ongoing eligibility based on CMS criteria. They act as a patient advocate within the care team, providing proactive outreach to value-based payer patients and collaborating with healthcare providers, families, and community resources to coordinate care and facilitate smooth transitions.
Key Responsibilities
- Assess and evaluate the Plan of Care (Home Health 485 form) for medical necessity and homebound status.
- Facilitate case conferences with Home Health agencies to review patient progress and discharge plans.
- Recommend recertification or discharge to primary care providers based on assessments and guidelines.
- Utilize MCG Guidelines to optimize care type, frequency, and duration.
- Build positive relationships with agencies, clinicians, and staff to ensure effective communication and care continuity.
- Navigate electronic medical records and care management tools efficiently.
- Monitor program success metrics and identify opportunities for improvement.
- Perform outreach focusing on medication adherence, self-management, follow-up care, and early warning signs of deterioration.
- Promote a caring environment by addressing the needs of patients and colleagues.
Qualifications & Skills
- Bachelor’s Degree in Nursing preferred.
- 3-5 years of clinical experience; 2+ years in home health and care management preferred.
- RN license in the relevant state or compact license required.
Millions of jobs, with real people getting hired every day
Questions, answered
Click "Apply with JobAssist" – we tailor your resume and application to this role and submit it for your approval.
Yes. This role at Black Women's Mental Health Institute was screened before publishing – we confirmed the employer before listing it.
The employer didn't disclose a salary range for this listing. JobAssist shows pay whenever it's available.
This position can be done from anywhere, with no in-office requirement.
Yes – every application is tailored from your profile and this job's requirements, and you can review and edit before it's sent.