Registered Nurse Navigator Home Health Review-HealthAdmin

Description 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