PACE Clinical Enrollment RN Manager

Work set-up: 
Full Remote
Contract: 
Experience: 
Mid-level (2-5 years)
Work from: 

Offer summary

Qualifications:

Bachelor's degree in Nursing (BSN) required., Current unrestricted Registered Nurse license., Minimum 2 years of clinical nursing experience in complex healthcare settings., Experience with regulatory compliance in Medicare/Medicaid programs..

Key responsibilities:

  • Lead clinical assessment and eligibility processes for PACE enrollment.
  • Manage multidisciplinary teams including RNs, social workers, and support staff.
  • Ensure compliance with DHCS and other regulatory requirements.
  • Drive improvements in approval rates, processing times, and team performance.

Habitat Health logo
Habitat Health Startup https://www.habitathealth.com/
2 - 10 Employees
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Job description

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of AllInclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente.

Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations.

Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https:www.habitathealth.com.

Role Scope:

Lead clinical assessment and eligibility determination processes for PACE program enrollment. Manage multidisciplinary teams including RN Supervisors, RNs, and social workers to ensure regulatory compliance with DHCS requirements while achieving quality outcomes and operational efficiency targets. Drive measurable improvements in approval rates, processing times, and team performance.

Clinical Operations Management (40%)

Oversee comprehensive clinical assessments and Initial Level of Care (ILOC) determinations for PACE eligibility

Lead multidisciplinary assessment teams including RNs, MSWs, and support staff

Review and approve complex eligibility cases requiring specialized clinical judgment

Coordinate Health & Safety and Behavioral Health committee processes

Ensure clinical assessments meet nursing facility level of care standards

Regulatory Compliance & Quality Assurance (30%)

Serve as primary liaison with DHCS for eligibility determinations and regulatory submissions

Ensure compliance with 42 CFR Part 460 PACE program regulations and state requirements

Implement and maintain quality review processes for all clinical documentation

Manage resubmission processes for deferred or denied applications

Develop and implement corrective action plans for regulatory compliance issues

Team Leadership & Staff Development (20%)

Supervise preenrollment clinical staff including performance management

Conduct team meetings and provide regulatory training

Ensure adequate staffing coverage and resource allocation

Mentor staff and support professional development initiatives

Foster collaborative multidisciplinary team relationships

Strategic Planning & Process Improvement (10%)

Optimize preenrollment workflows to improve processing efficiency

Monitor KPIs including approval rates, processing times, and quality metrics

Lead continuous improvement initiatives

Participate in organizational strategic planning for enrollment capacity

Provide clinical expertise to senior leadership

Qualifications:

Required profile

Experience

Level of experience: Mid-level (2-5 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Other Skills

  • Team Leadership
  • Analytical Skills
  • Leadership Development
  • Verbal Communication Skills

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