Clinical Documentation Reviewer, RN
About The Position
WelbeHealth is a value-based healthcare organization that’s transforming the future of senior care by providing an all-inclusive care option to our most vulnerable senior population. We step in as the care provider and care planner that work to keep our participants within their communities, out of institutions, and cared for like family, all while receiving the healthcare and social services needed to thrive. The Central Enrollment RN Reviewer plays an important role in supporting the centralized enrollment review and eligibility requirement determination process. Reporting into Central ERD leadership, this position is accountable for conducting clinical reviews of prospective participant enrollment documentation to support consistent, accurate, compliant, and timely enrollment determinations across WelbeHealth markets. This role is different because the Central Enrollment RN Reviewer at WelbeHealth: Operates in a fully remote role that encourages flexibility and balance Reviews a managed weekly documentation volume, enabling thorough and high-quality assessments Plays a critical role in supporting a growing, mission-driven healthcare organization, ensuring vulnerable seniors feel supported and have access to high-quality care
Requirements
- Active, unrestricted Registered Nurse (RN) license in good standing required
- Minimum of three (3) years of PACE experience
- 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
Nice To Haves
- Experience using Excel, Word, Teams, electronic health records, enrollment trackers, clinical documentation platforms, or other healthcare systems preferred
Responsibilities
- Conduct clinical review of Level of Care assessments, enrollment documentation, tracker information, and supporting records to evaluate prospective participant readiness for centralized enrollment review
- Utilize approved Central ERD criteria, organizational guidelines, professional nursing judgment, and knowledge of state-specific regulatory requirements to drive consistent, compliant, and standardized enrollment recommendations and determinations across assigned markets
- Identify medical, functional, psychosocial, behavioral health, cognitive, housing, home safety, and operational considerations that may require additional review, follow-up, or interdisciplinary coordination
- Identify cases requiring escalation or additional evaluation by Medical Directors, Executive Directors, PMHNPs, Social Workers, Pharmacists, Home Care team members, Facilities or delegates, Compliance team members, or other applicable stakeholders
- Document review findings, classification considerations, follow-up needs, recommendations, and decision-support notes in a timely and accurate manner in required systems, including Excel trackers, electronic health record systems, and other designated platforms
- Participate in Central ERD meetings, case review discussions, and related process cadence to support timely enrollment decisions and appropriate operational handoff
- Communicate clearly and professionally with Enrollment RNs, MOE team members, market leaders, clinical stakeholders, and Central ERD leadership regarding review findings, documentation gaps, and participant readiness considerations
Benefits
- Medical insurance coverage (Medical, Dental, Vision)
- 17 days of personal time off (PTO)
- 12 holidays observed annually
- 6 sick days
- 401K savings + match
- Comprehensive compensation package including base pay and bonus
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
