Enrollment Coordinator RN
2 days ago
Fallon Health is a company that prioritizes its members' needs, ensuring they receive the care they deserve. With a strong commitment to equitable and high-quality coordinated care, we strive to be the leading provider of government-sponsored health insurance programs in the region.
Job SummaryWe are seeking an experienced Enrollment Coordinator RN to join our team. As a key member of our enrollment team, you will be responsible for assessing clinical eligibility, managing data, and ensuring compliance with Medicaid eligibility guidelines and PACE regulations.
Responsibilities- Conduct clinical eligibility assessments and establish monthly goals for enrollment.
- Respond to individual inquiries regarding Summit ElderCare, including phone calls, website inquiries, home visits, and hospital visits.
- Review the enrollment process with potential members, families, and referral sources.
- Determine individual monthly premiums and eligibility for Medicaid assistance.
- Complete the MDS, estimate eligibility, and enter data into the Virtual Gateway.
- Communicate with the Interdisciplinary Team to provide information for enrollment decisions and ongoing communication with referral sources.
- Coordinate and communicate necessary information about potential enrollees to the Summit Site Director.
- Provide referrals to other programs for individuals not suitable for SE and those who choose not to enroll.
- Facilitate weekly enrollment meetings.
- Maintain uniformity in data collection and prepare weekly reports regarding referrals and enrollments.
- BSN degree preferred.
- Current RN license to practice in Massachusetts and valid driver's license required.
- 2 years' experience working with the elderly, preferably in a community setting.
- Knowledge of sales, customer service, outreach, and marketing principles and practices preferred.
- Knowledge of Medicaid eligibility requirements and case management experience desirable.
Fallon Health provides equal employment opportunities to all employees and applicants for employment, prohibiting discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity, or expression.
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