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Enrollment Coordinator RN

1 month ago

North Dartmouth, United States Fallon Health Full time

About Fallon Health

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Our mission is to improve health and inspire hope.

Job Summary

We are seeking a skilled Enrollment Coordinator RN to join our team. As an Enrollment Coordinator RN, you will be responsible for assessing clinical eligibility, determining individual monthly premiums, and communicating with the Interdisciplinary Team to provide information for enrollment decisions.

Responsibilities

  • Participate in establishing monthly goals for enrollment.
  • Respond to individual inquiries regarding Summit ElderCare, including phone calls, web site inquiries, home visits, hospital and nursing home visits.
  • Review the enrollment process with potential members/families/referrers.
  • Determine individuals 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/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.

Requirements

  • Education: Degree in Nursing, BSN preferred.
  • Licenses/Certifications: RN, current license to practice in Massachusetts and Valid Drivers 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.