Fallon Health Enrollment Coordinator-New Senior Services PACE Program in Webster! in Webster, Massachusetts
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.
About Summit ElderCare :
Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.
Brief Summary of Purpose :
The Enrollment Coordinator RN follows leads for prospective PACE enrollees provided by the outreach team from initial home visit through enrollment, obtains the initial clinical, financial and social information needed to complete clinical eligibility assessments, assuring that prospective enrollees meet the eligibility requirements for the PACE program, and presents information to the Interdisciplinary Team in an accurate and concise manner. The RN keeps the team informed of issues that affect enrollment decisions and maintains data; reports to Site Director with the support of the SE Senior Enrollment Coordinator RN.
Clinical eligibility assessment
Participates in establishing monthly goals for enrollment.
Responds to individual inquiries regarding Summit ElderCare, including but not limited to, phone calls, web site inquiries, home visits, hospital and nursing home visits.
Reviews the enrollment process with potential members/families/referrers.
Determines individual’s monthly premium and eligibility for Medicaid assistance.
Completes the MDS, estimates whether individual meets clinical criteria for enrollment, and enters MDS into the Virtual Gateway. Manages questions from EOEA.
Communicates with the Interdisciplinary Team to provide information for enrollment decisions and provides ongoing communication with referral sources, potential enrollees/families during the intake process.
Coordinates and communicates necessary information about potential enrollees to the Summit Site Director on an ongoing basis.
Provides referrals to other programs for individuals not appropriate for SE and for those who choose not to enroll.
Facilitates weekly enrollment meetings.
Keeps informed of NaviCare eligibility requirements and makes referrals as appropriate.
Assist with completion of MDS assessments annually at assigned SE site.
Data management and reporting
Assures uniformity in data collection.
Prepares weekly reports regarding referrals and enrollments.
Maintains referral tracking system and contact file.
Participates in planning home visit requests. Attends home visits and completes documentation in the electronic medical record and attends intake meetings at their respective site followed by documentation in the electronic medical record. Prioritizes home visits according to forecast. Updates the home visit database. Initiates the opening of the EMR and enters clinical and demographic information.
Conducts clinical presentations as required.
- Keeps informed of general Medicaid eligibility guidelines and supplemental insurance issues as they affect SE enrollment as well as the Medicare CMS regulation for PACE.
- Degree in Nursing, BSN preferred
RN, current license to practice in Massachusetts
Valid Driver’s License and Clean Driving Record 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 desirable
Case management experience desirable
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits 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, or any other characteristic protected by federal, state or local laws.
Posted Date 1 month ago (3/10/2021 5:21 PM)
Job ID 6267
# Positions 1
Category Care Coordination