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Enrollment Coordinator RN

2 months ago

North Dartmouth Dartmouth MA USA, United States Fallon Health Full time
About Fallon Health

Fallon Health is a healthcare organization that prioritizes its members' needs, ensuring they receive the care they deserve. With a strong commitment to equity and quality, we deliver coordinated care and are consistently rated among the nation's top health plans for member experience, service, and clinical quality.

We believe in the value of diversity and inclusion, embracing individual differences and promoting a culture of respect and empathy. Our mission is to improve health and inspire hope, guiding us to be the leading provider of government-sponsored health insurance programs in the region.

Responsibilities

As an Enrollment Coordinator RN, you will be responsible for:

  • Clinical Eligibility Assessment
    • Participate in establishing 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 premium and eligibility for Medicaid assistance.
    • Complete the MDS, estimate whether individual meets clinical criteria for enrollment, and enter MDS into the Virtual Gateway.
    • Communicate with the Interdisciplinary Team to provide information for enrollment decisions and provide ongoing communication with referral sources, potential enrollees, and families during the intake process.
    • Coordinate and communicate necessary information about potential enrollees to the Summit Site Director on an ongoing basis.
    • Provide referrals to other programs for individuals not appropriate for SE and for those who choose not to enroll.
    • Facilitate weekly enrollment meetings.
    • Keep informed of NaviCare eligibility requirements and make referrals as appropriate.
    • Assist with completion of MDS assessments annually at assigned SE site.
  • Data Management and Reporting
    • Assure uniformity in data collection.
    • Prepare weekly reports regarding referrals and enrollments.
    • Maintain referral tracking system and contact file.
    • Participate in planning home visit requests. Attend home visits and complete documentation in the electronic medical record and attend intake meetings at their respective site followed by documentation in the electronic medical record.
    • Conduct clinical presentations as required.
  • Monitors Compliance
    • Keep informed of general Medicaid eligibility guidelines and supplemental insurance issues as they affect SE enrollment as well as the Medicare CMS regulation for PACE.
    Qualifications

To be successful in this role, you will need:

  • Education
    • Degree in Nursing, BSN preferred.
  • Licenses/Certifications
    • RN, current license to practice in Massachusetts and Valid Driver's License and Clean Driving Record Required.
  • Experience
    • 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 desirable.
    • Case management experience desirable.