Central Pre-Enrollment Nurse Practitioner

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $116k - $152k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Habitat Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2023

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Habitat Health is a healthcare organization focused on empowering older adults to live independently in their homes and communities. Through the Program of All-Inclusive Care for the Elderly (PACE), Habitat Health provides comprehensive health insurance coverage and medical and social care services. Their services include transportation, personal care, 24/7 care access, physical therapy, nutrition support, pharmacy and prescriptions, medical care, and social services. Operating in partnership with notable healthcare providers such as Kaiser Permanente, Habitat Health is committed to creating a supportive and inclusive environment for both participants and staff, ensuring the provision of personalized, coordinated care. Founded in 2023, the company aims to enhance the lives of older adults covered by Medicare or Medicaid.

📋 Description

• Conduct thorough and complete chart reviews for PACE applicants, evaluating medical records, diagnostic history, functional status, and clinical documentation to capture all factors relevant to eligibility determination and potential H&S denial • Present cases to Site Medical Directors as needed based on departmental guidelines and policy, ensuring all clinical findings are clearly communicated to support informed eligibility decisions • Collaborate closely with Enrollment RNs (ERNs) and Site Medical Directors to ensure documentation gaps are identified and resolved prior to submission; serve as the escalation point when ERNs are unable to obtain required diagnostic information • Provide clinical expertise for Health & Safety determinations, including participation in H&S Committee meetings; when chart review reveals diagnostic gaps that cannot be resolved by the ERN, conduct virtual clinical assessments to obtain or confirm required diagnoses and ensure chart completeness prior to submission • Review ILOC clinical summaries to ensure clear connections between medical conditions, functional limitations, and PACE services are documented to regulatory standard • Support quality improvement initiatives aimed at maintaining high first-pass DHCS approval rates and reducing documentation deficiencies • Serve as a clinical resource for the Pre-Enrollment team on complex cases, supporting accuracy and thoroughness in ILOC documentation to protect the organization's H&S denial integrity

🎯 Requirements

• Current, unrestricted Nurse Practitioner (NP) or Physician Assistant (PA) license in California • Current DEA certification and furnishing/prescriptive authority in California • Minimum 3 years of post-licensure NP clinical experience in geriatrics, long-term care, or PACE-adjacent setting • Demonstrated chart review proficiency: ability to capture all factors relevant to PACE eligibility and H&S denial determinations • Competency with geriatric assessment tools: BIMS, PHQ-9, MoCA, MMSE, ADL/IADL scales • Strong ILOC documentation skills meeting California Title 22 and 42 CFR Part 460 standards • Proficiency with Epic EHR and Microsoft Outlook; ability to manage high-volume time-sensitive communication in a fast-paced department • Experience working in interdisciplinary team environments with physicians, RNs, and social workers • Understanding of CMS and DHCS regulations related to PACE eligibility and NFLOC criteria • Ability to practice collaboratively with Habitat Health PACE Site Medical Directors across multiple California sites • Experience presenting complex cases to Medical Directors in a fast-paced clinical environment • Cultural competence and experience working with diverse elderly populations.

🏖️ Benefits

• medical, dental, and vision insurance • paid parental leave • short- and long-term disability coverage • life insurance • flexible spending accounts • 401(k) savings plan that includes a match • paid time off • company paid holidays