Rn Jobs

About The Position

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