Lead Enrollment Outreach Registered Nurse

Uphams Corner Health Center • Boston, MA

244d

About The Position

The Enrollment Outreach Registered Nurse (RN) plays a critical role in the intake, enrollment, and marketing team, ensuring regulatory compliance and clinical integrity within the enrollment and reassessment process. This RN conducts clinical assessments to determine eligibility for the PACE program and ensures adherence to regulations set forth by both the Executive Office of Health and Human Services (EOHHS). In addition, the Enrollment Outreach RN coordinates the Centers for Medicare & Medicaid Services (CMS) MDS Integrity Program for PACE, ensuring accuracy, timeliness, and compliance with state and federal requirements. This role is ideal for a highly organized and detail-oriented RN who thrives in a regulatory-driven environment while making a meaningful impact on older adults' access to PACE services.

Requirements

• Registered Nurse (RN) with a valid Massachusetts license.
• Minimum 1 year of experience in home care, admissions, or working within a PACE or Senior Care Options (SCO) program.
• Strong knowledge of EOHHS and CMS regulations related to PACE eligibility and assessments.
• Experience in completing MDS assessments preferred.
• Excellent organizational, planning, and tracking skills to manage the MDS process effectively.
• Prior experience coordinating regulatory assessments and audits.
• Experience working with interdisciplinary teams in a healthcare setting.
• Strong written and verbal communication skills in English; bilingual candidates a plus.
• Proficiency in electronic medical records (EMR) and data entry.
• CPR certification required.
• Ability to conduct home visits and interact with participants in their home settings.

Responsibilities

• Ensure compliance with EOHHS and CMS regulations, policies, and documentation standards.
• Serve as the MDS Integrity Program Coordinator, ensuring the accuracy and timeliness of assessments and submissions.
• Complete and submit initial and annual MDS assessments to the State Administering Agency (SAA) to determine and maintain participants' clinical eligibility for PACE.
• Oversee the PACE eligibility reassessment and recertification process, ensuring all requirements are met.
• Maintain organized tracking and reporting of MDS assessments to ensure timely completion and submission.
• Communicate effectively with the SAA and regulatory agencies as required.
• Conduct home visits to provide clinical assessments for pre-enrollees, independently or in collaboration with the Intake Coordinator.
• Assist the Intake Coordinator in completing the Intake Prospect Sheet for each pre-enrollee home visit.
• Provide clinical information to the Interdisciplinary Team (IDT) and contribute to the completion of the initial MDS and provisional care plan.
• Serve as a liaison between PACE and the pre-enrollee's existing home care services.
• Participate in IDT discussions to support enrollment decisions and care planning.
• Ensure timely data entry and documentation in the Electronic Medical Record (EMR).
• Provide clinical outreach and education to community referral sources in collaboration with the Intake/Enrollment /Marketing Department.
• Maintain regular communication and updates with clinical partners regarding the eligibility status of potential enrollees.
• Represent PACE in the community by supporting marketing and outreach initiatives as needed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree