Job Description

Registered Nurse Navigator Home Health Review-Health Admin at Christus Health summary:

The Registered Nurse Navigator for Home Health Review ensures that home health patients continue to meet CMS criteria by coordinating care, providing patient advocacy, and making service recommendations to primary care providers. They facilitate communication among healthcare teams, support care transitions, and monitor compliance with guidelines to optimize patient outcomes. This role requires clinical expertise, use of care management tools, and collaboration with home health agencies and physicians to improve patient care continuity.

Summary:

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. They are a member of the patient’s care team and act as a patient advocate, providing proactive outreach to CHRISTUS Health value-based payer patients. The RN Navigator makes recommendations to primary care providers regarding ongoing services. The RN Navigator facilitates communication and coordinates care with physicians, the providers’ clinic, hospital facilities, family, caregivers, and other community healthcare providers. The Associate will support transitions of care as needed.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Stays abreast of current CMS and other payer guidelines for Home Health services.
• Receives and evaluates Home Health 485 form (Plan of Care) based on Medical Necessity guidelines and Homebound Status requirements.
• Facilitates Case Conferences with Home Health Agencies for evaluation of patient progress toward goals and discharge plan.
• Ensures Home Health agency is addressing the problem list and providing appropriate follow up for patient needs.
• Based on CMS or other payer guidelines, patient assessment, and case conferences, makes recommendation to PCP regarding Home Health recertification or discharge from service.
• Utilizes MCG Guidelines for Home Care to optimize the type, frequency, and duration of care.
• Creates positive relationships with Home Health agencies as well as Primary Care Clinicians and Office Staff.
• Ensures smooth transition of care along the continuum.
• Facilitates communication between Home Health agencies and PCP practices as necessary to ensure patient's needs are addressed.
• Demonstrates expertise in navigating electronic medical record and other care management applications.
• Monitors key measures of program success and provides feedback regarding opportunities to improve.
• Collaborates with team members in the discharge process, performing outreach/documentation according to CMS guidelines and the Population Health workflow.
• Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond.
• Promotes a positive work environment by displaying a caring, sensitive approach to others, as evidenced by listening, understanding, and responding to the needs of patients, colleagues, and supervisors.
• Performs other duties as assigned.

Job Requirements:

Education/Skills

• Bachelor’s Degree in Nursing preferred.

Experience

• 3-5 years of clinical experience required.
• 2 years of Home health experience preferred.
• 2-3 years of managed care and/or care management experience preferred.

Licenses, Registrations, or Certifications

• RN license in the state of employment or compact is required.

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Keywords:

Registered Nurse, Home Health, Care Coordination, Patient Advocacy, CMS Compliance, Care Transitions, Managed Care, Patient Monitoring, Healthcare Communication, Nursing Care Management

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