RN Navigator Home Health Review

9182648 RN Navigator Home Health Review, Irving, TX, 3-Month Contract
Sigma Inc. is currently looking for a RN Navigator Home Health Review to work on-site with our team in Irving, TX.

Shift Timings: Monday to Friday, 8 am to 5 PM

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 Client 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.

Requirements:

• Bachelor's degree in nursing preferred.
• 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 Texas
• 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.