Nurse Navigator HME

We are seeking a skilled Nurse Navigator HME to join our durable medical services team. This role is crucial in assessing patient needs, coordinating care, and ensuring effective communication among all parties involved in patient care.

The Nurse Navigator HME ("Home Medical Equipment") is responsible for coordinating, reviewing, and managing the authorization and delivery of durable medical equipment ("DME") for patients based on their clinical needs. Utilizing advanced clinical knowledge and nursing judgment, this role ensures that requested medical equipment aligns with clinical necessity, regulatory guidelines, and patient care plans. The Nurse Navigator HME serves as a critical liaison between physicians, patients, families, and equipment vendors to optimize patient independence and safety at home. This position typically reports to a Director or above Director of HME Operations.

Responsibilities

Essential Duties and Responsibilities
• Clinical Review & Utilization Management: Evaluate medical records, physician prescriptions, and clinical documentation to determine the medical necessity of complex DME requests.
• Patient & Caregiver Education: Assess patient and family understanding of equipment operation, safety protocols, and maintenance, providing virtual or telephonic clinical guidance as needed.
• Interdisciplinary Collaboration: Partner with physicians and home healthcare agencies' case managers to modify care plans and troubleshoot barriers to equipment acquisition.
• Compliance & Quality Assurance: Ensure compliance with HIPAA, EEOICPA, and Company standards and policies.
• Documentation: Maintain compliant electronic health records detailing clinical justifications that are in-line with patient care plans.

Qualifications

What We're Looking For

Current RN License: Valid and active Registered Nurse license in good standing.
• Education: Graduate of an accredited School of Nursing.
• Licensure: Active, unrestricted Registered Nurse (RN) license in the state of practice or RN compact license.
• Experience: Minimum of 2-3 years of clinical nursing experience. Prior experience in home health, utilization review, case management, or a DME environment is highly preferred.

Pay Range

USD $83,000.00 - USD $93,600.00 /Yr.