Enrollment Coordinator RN
Fallon Health
- Dartmouth, MA
- Permanent
- Full-time
- 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.
- 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
- 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