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Salary: USD 99,309.58 - 131,088.64 / annual
WelbeHealth is a value-based healthcare organization transforming senior care by providing all-inclusive care options to vulnerable seniors, keeping them within their communities while delivering comprehensive healthcare and social services.
The Central Enrollment RN Reviewer plays a critical role in the centralized enrollment review and eligibility determination process. Reporting to Central ERD leadership, you will conduct clinical reviews of prospective participant enrollment documentation to ensure consistent, accurate, compliant, and timely enrollment determinations across WelbeHealth markets.
Key responsibilities include:
- Conducting clinical reviews of Level of Care assessments, enrollment documentation, tracker information, and supporting records to evaluate prospective participant readiness
- Applying approved Central ERD criteria, organizational guidelines, professional nursing judgment, and state-specific regulatory knowledge to drive consistent enrollment recommendations
- Identifying medical, functional, psychosocial, behavioral health, cognitive, housing, home safety, and operational considerations requiring additional review or interdisciplinary coordination
- Identifying cases requiring escalation to Medical Directors, Executive Directors, PMHNPs, Social Workers, Pharmacists, Home Care teams, Facilities, Compliance, or other stakeholders
- Documenting review findings, classifications, follow-up needs, recommendations, and decision-support notes in Excel trackers, electronic health records, and other designated platforms
- Participating in Central ERD meetings, case review discussions, and process cadence to support timely enrollment decisions
- Communicating clearly with Enrollment RNs, MOE team members, market leaders, clinical stakeholders, and Central ERD leadership regarding findings and participant readiness
This fully remote role emphasizes flexibility and work-life balance, with a managed weekly documentation volume enabling thorough, high-quality assessments. You'll play a critical role supporting a mission-driven healthcare organization serving vulnerable seniors.
Requirements:
- Active, unrestricted Registered Nurse (RN) license in good standing (required)
- Minimum three (3) years of PACE experience (required)
- PACE managed care, utilization review, care coordination, quality review, or regulatory healthcare experience (required)
- Demonstrated experience reviewing clinical documentation, conducting clinical assessments, supporting case reviews, or coordinating care across interdisciplinary teams
- Strong clinical judgment, critical thinking, and ability to identify potential participant safety, care coordination, and operational risks
- Experience using Excel, Word, Teams, electronic health records, enrollment trackers, clinical documentation platforms, or other healthcare systems (preferred)
