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 OneCHRISTUS 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 delivery.
• Ensures smooth transitions of care along the continuum, facilitating communication between Home Health agencies and PCP practices as necessary to address patient needs.
• Demonstrates expertise in navigating electronic medical records and other care management applications.
• Monitors key measures of program success and provides feedback regarding opportunities for improvement.
• Collaborate with team members in the discharge process, performing outreach and documentation according to CMS guidelines and the Population Health workflow.
• Promotes a positive work environment by displaying a caring, sensitive approach to others, 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 years of clinical experience required.
• 2 years of Home Health experience preferred.
• 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.

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time