RN Navigator – Home Health Review

Job ID: 9182648
Location: Irving, TX
Job Type: 3-Month Contract
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Work Arrangement: Onsite

Job Overview

Sigma Inc. is seeking an experienced RN Navigator – Home Health Review to support post-acute patient care in Irving, TX. This role focuses on reviewing Home Health services, CMS requirements, medical necessity, and patient progress to help ensure patients receive appropriate care while meeting applicable payer guidelines.

The RN Navigator will work closely with Home Health agencies, Primary Care Providers (PCPs), clinical teams, and office staff to coordinate care, facilitate transitions, and make recommendations regarding continued Home Health services, recertification, or discharge.

Key Responsibilities

• Review post-acute Home Health services to ensure patients continue to meet CMS and payer requirements.
• Stay current with CMS guidelines and payer requirements related to Home Health services.
• Review Home Health 485 Plans of Care for medical necessity and Homebound Status requirements.
• Evaluate patient progress and participate in case conferences with Home Health agencies.
• Review discharge plans and ensure agencies address patient problem lists and follow-up needs.
• Make recommendations to Primary Care Providers regarding Home Health recertification or discharge.
• Utilize MCG Guidelines to help determine the appropriate type, frequency, and duration of post-acute care.
• Develop positive working relationships with Home Health agencies, PCPs, clinicians, and office staff.
• Coordinate communication between Home Health agencies and PCP practices to support effective care delivery.
• Facilitate transitions of care across the healthcare continuum.
• Navigate Electronic Medical Records (EMR) and care management applications.
• Monitor program performance measures and identify opportunities for improvement.
• Support the discharge process through patient/facility outreach and accurate documentation.
• Document activities according to CMS requirements and Population Health workflows.
• Promote a patient-centered, collaborative, and professional work environment.
• Perform other duties as assigned.

Required Qualifications

• Registered Nurse (RN) with an active Texas RN license.
• Minimum 3 years of clinical nursing experience.
• Bachelor's degree in Nursing (BSN) preferred.
• 2+ years of Home Health experience preferred.
• 3+ years of managed care and/or care management experience preferred.
• Experience with post-acute care, utilization review, case management, or care coordination is highly relevant.
• Strong understanding of clinical documentation, patient assessment, and care planning.
• Familiarity with CMS guidelines, medical necessity, and Home Health requirements is preferred.
• Strong communication, collaboration, organization, and documentation skills.
• Comfortable working with EMR systems and care management technology.