Clinical Enrollment Specialist RN

7 days 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. Founded in 1977 in Massachusetts, we deliver high-quality, coordinated care and are consistently rated among the nation's top health plans for member experience, service, and clinical quality.

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

Job Summary

We are seeking a skilled Enrollment Coordinator RN to join our team. As a Clinical Eligibility Specialist, you will play a critical role in establishing monthly goals for enrollment, responding to inquiries, and determining individual eligibility for Medicaid assistance.

Key Responsibilities
  • 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 individual eligibility, 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 and potential enrollees.
    • 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 for those who choose not to enroll.
    • Facilitate weekly enrollment meetings.
    • Keep informed of NaviCare eligibility requirements and make referrals as necessary.
    • Assist with completion of MDS assessments annually at assigned SE sites.
  • Data Management and Reporting
    • Assure uniformity in data collection.
    • Prepare weekly reports regarding referrals and enrollments.
    • Maintain referral tracking systems and contact files.
    • Participate in planning home visit requests, attend home visits, and complete documentation in the electronic medical record.
    • Conduct clinical presentations as required.
  • Monitors Compliance
    • Keep informed of general Medicaid eligibility guidelines and supplemental insurance issues affecting SE enrollment and Medicare CMS regulations for PACE.
    Qualifications

We are seeking a candidate with a degree in Nursing, preferably a BSN. The ideal candidate will have 2 years of experience working with the elderly, preferably in a community setting. Knowledge of sales, customer service, outreach, and marketing principles and practices is preferred. Experience with Medicaid eligibility requirements and case management is also desirable.

COVID-19 Vaccination

Fallon Health no longer requires all employees to be vaccinated against COVID-19, except for employees in jobs that require vaccination under state and federal laws and regulations.

Equal Employment Opportunity

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.

  • Enrollment Coordinator RN

    7 days ago

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

    About Fallon HealthFallon Health is a healthcare organization that prioritizes its members' needs, ensuring they receive the care they deserve. Founded in 1977 in Massachusetts, we deliver high-quality, coordinated care and are consistently rated among the nation's top health plans for member experience, service, and clinical quality.We believe in embracing...

  • Enrollment Coordinator RN

    5 days ago

    North Dartmouth, United States Fallon Health Full time

    About the RoleFallon Health is seeking a highly skilled Enrollment Coordinator RN to join our team. As a key member of our organization, you will play a critical role in ensuring that our members receive the care they need and deserve.Key ResponsibilitiesClinical Eligibility AssessmentParticipate in establishing monthly goals for enrollment and ensure that...

  • Enrollment Coordinator RN

    4 days ago

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

    About Fallon HealthFallon 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...

  • Enrollment Coordinator RN

    2 months ago

    North Dartmouth, United States Fallon Health Full time

    Overview: About us: Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nations top health plans for member experience, service, and clinical quality. ...

  • Clinical Enrollment Specialist

    5 days ago

    Boston, MA , USA, United States Element Care Full time

    Job SummaryElement Care is seeking a highly skilled Clinical Enrollment Specialist to join our team. As a key member of our enrollment team, you will play a vital role in prioritizing, organizing, and adapting the PACE enrollment process to meet the individualized needs of potential participants and ensure census goals are achieved.Key...

  • Healthcare Outreach Specialist

    7 days ago

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

    About Fallon HealthWe are a healthcare organization that prioritizes our members' needs and provides equitable, high-quality coordinated care. Our mission is to improve health and inspire hope.Job SummaryThis position requires a skilled Outreach Account Executive to achieve personal referral/sales/outreach goals for our Summit Elder Care program. The...

  • Clinical Administrative Specialist

    7 days ago

    Dartmouth, MA , USA, United States Claris Vision Full time

    Job SummaryAt Claris Vision, we are seeking a highly skilled Patient Service Representative to join our team. As a Patient Service Representative, you will play a vital role in ensuring the smooth operation of our clinic by providing exceptional patient care and administrative support.Key ResponsibilitiesPatient Registration and Scheduling: Register...

  • Clinical Enrollment Specialist

    2 weeks ago

    Brighton, MA, United States Element Care Full time

    Job SummaryElement Care is seeking a highly skilled Clinical Enrollment Specialist to join our team. As a key member of our enrollment team, you will play a critical role in prioritizing, organizing, and adapting the PACE enrollment process to meet the individualized needs of potential participants.Key ResponsibilitiesEnrollment Team ResponsibilitiesConduct...

  • Clinical Enrollment Specialist

    1 day ago

    Brighton, MA, United States Element Care Full time

    Job SummaryElement Care is seeking a highly skilled Clinical Enrollment Specialist to join our team. As a key member of our enrollment team, you will play a vital role in prioritizing, organizing, and adapting the PACE enrollment process to meet the individualized needs of potential participants.Key ResponsibilitiesEnrollment Team ResponsibilitiesConduct...

  • Sports Medicine Specialist

    5 days ago

    North Dartmouth, United States Southcoast Health System Full time

    About the RoleSouthcoast Health System is seeking a highly skilled Sports Medicine Specialist to join our team. As an Athletic Trainer - Injury Prevention Specialist, you will play a critical role in promoting the health and well-being of our employees.Key ResponsibilitiesProvide athletic training outreach services at contracted high schools to promote...

  • Sports Medicine Specialist

    7 days ago

    North Dartmouth, United States Southcoast Health System Full time

    About the RoleSouthcoast Health System is seeking a highly skilled Sports Medicine Specialist to join our team. As an Athletic Trainer - Injury Prevention Specialist, you will play a critical role in providing top-notch care to our patients and promoting a culture of well-being within our organization.Key ResponsibilitiesUnder the direction of the Manager,...

  • Clinical Site Director – New Elder Services Day Center

    1 week ago

    North Dartmouth, United States Fallon Health Full time

    Overview:Want to apply Read all the information about this position below, then hit the apply button.COMING SOON: Fallon Health Opens New Summit Eldercare Site in Dartmouth, MA!!About Summit ElderCare:Fallon Health operates one of the largest Programs of All-Inclusive Care for the Elderly (PACE) in the country. Called Summit ElderCare, Fallon’s PACE...

  • Part Time Lecturer Position

    4 days ago

    North Dartmouth, United States UMass Dartmouth Full time

    Job Opportunity at UMass DartmouthCollege of Nursing and Health SciencesDepartment of Adult NursingPart-Time Lecturer PositionsThe Department of Adult Nursing invites applications for part-time lecturer positions at the undergraduate and graduate level. Positions are available for clinical and didactic assignments. Part-time faculty are expected to engage in...

  • Veterinary Care Specialist

    4 days ago

    North Dartmouth, United States Dagenais Veterinary Clinic Full time

    About Dagenais Veterinary ClinicWe are a privately owned small animal hospital seeking a skilled Veterinary Care Specialist to join our team.Job SummaryThis is a great opportunity for a dedicated and compassionate Companion Animal Doctor to work with a successful and well-known veterinarian in a beautiful coastal area.ResponsibilitiesPerform medical...

  • Adjunct Faculty in Nursing

    1 week ago

    North Dartmouth, United States UMass Dartmouth Full time

    College of Nursing and Health SciencesDepartment of Adult NursingPart-Time Faculty OpportunitiesThe Department of Adult Nursing is seeking applications for part-time faculty positions at both undergraduate and graduate levels. These roles encompass clinical and theoretical teaching assignments. Part-time educators are expected to participate in course-based...

  • Adjunct Faculty in Nursing Education

    2 weeks ago

    North Dartmouth, United States UMass Dartmouth Full time

    College of Nursing and Health SciencesDepartment of Adult NursingPart-Time Faculty OpportunitiesThe Department of Adult Nursing is seeking applications for part-time faculty positions at both undergraduate and graduate levels. These roles encompass clinical and theoretical instruction. Part-time educators are expected to participate in ongoing course...

  • Activity Therapist PRN

    7 days ago

    Dartmouth, United States Southcoast Behavioral Health Full time

    Job SummaryWe are seeking a highly skilled Activity Therapist PRN to join our team at Southcoast Behavioral Health. As a key member of our interdisciplinary treatment team, you will be responsible for planning, directing, and implementing activity therapy programs that promote patient progress and well-being.Key ResponsibilitiesActivity Assessment and...

  • Adjunct Lecturer Opportunities in Nursing Education

    7 days ago

    North Dartmouth, United States UMass Dartmouth Full time

    Job SummaryWe are seeking highly qualified part-time faculty members to join our team at the College of Nursing and Health Sciences at UMass Dartmouth. As a part-time lecturer, you will have the opportunity to teach undergraduate and graduate-level courses in adult nursing, including clinical and didactic assignments.ResponsibilitiesTeach undergraduate and...

  • NP-APRN-Psychiatry-SPG

    3 weeks ago

    Dartmouth, United States Southcoast Health System Full time

    OverviewFind out for yourself why Southcoast Health has been voted 'Best Place to Work' for 6 years in a row! Join Southcoast Health, where your future is as promising as the care we provide. Our commitment to each other, our patients, and our community is more than a mission - it's our way of life, and you'll be at the heart of it. Southcoast Health is a...

  • RN - Home Health

    3 weeks ago

    Dartmouth, United States Enhabit Home Health & Hospice Full time

    Overview Office Location: Lakeville Full-time, part-time and weekend schedules available to service our patients in Acushnet, New Bedford, Dartmouth and Fall River Are you in search of a new career opportunity that makes a meaningful impact? If so, now is the time to find your calling at Enhabit Home Health & Hospice. As a national leader in home-based...