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RN Enrollment Coordinator - Elder Care
Fallon Community Health Plan
Worcester, Massachusetts, 01601, US,  
Job Description:


Job ID: 4492

# Positions: 1

Posted Date: 7/12/2016 10:29:00 AM

Category: Care Coordination

Product Line: Summit ElderCare

Overview:

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 the only health plan in Massachusetts to have been awarded "Excellent" Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.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 social support and most medical services at a Summit ElderCare site while they keep the independence of living in their own homes and communities.

Position Overview:

The Enrollment Coordinator RN generates and follows leads for prospective enrollees, obtains the initial clinical, financial and social information needed to complete assessments, assures 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 and reports as assigned by the Enrollment Manager.


Responsibilities:

  • 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 and the Summit ElderCare Member Handbook with potential members/families.
  • Determines individual's monthly premium and eligibility for Medicaid assistance
  • Completes the MDS, estimates whether individual meets clinical criteria for enrollment, and submits 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.
  • Identifies Quality Improvement issues to the Director of Operations and Manager of Quality and participates in the development and implementation of the SE Quality Improvement Plan as directed.
  • Assures uniformity in data collection
  • Prepares weekly reports regarding referrals and enrollments.Maintains referral tracking system and contact file.Participates in planning and analysis of home visit requests and enrollments.
  • Prioritizes home visits according to forecast. Updates the home visit database. Intiates 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 regulstion for PACE


Qualifications:

  • Degree in Nursing, BSN preferred
  • RN, current license to practice in Massachusetts
  • MA driver's license
  • 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 MDS 2.0 process desirable
  • Knowledge of Medicaid eligibility requirements desirable
  • Case management experience desirable




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