Manager, Eligibility RN | M-F | 8-4:30

InnovAge Holding Corp.; Denver (CO); On-site; USD 103,000 - 134,000; Full time

Job summary

InnovAge is seeking a Manager who, under the Director, collaborates with Eligibility RNs, Sales and Enrollment Representatives to determine the eligibility of potential PACE participants. Physical attendance at an InnovAge facility or a participant home is essential to performing duties.

The role includes supervising local Eligibility RNs, coordinating IDT and clinic visits, ensuring accurate enrollment documentation, and maintaining up-to-date knowledge of Medicare/Medicaid guidelines to

Qualifications

• Associates degree from accredited nursing school.
• Current Registered Nurse license in state of work.
• First Aid and BLS certifications required prior to hire (AHA/Red Cross).

Responsibilities

• Determine eligibility for PACE participants with Eligibility RNs.
• Oversee home visits and clinic appointments to assess eligibility.
• Complete eligibility referral documents for enrollment applications.
• Coordinate with state Medicaid and Sales/Enrollment on eligibility decisions.
• Support business development and census growth through outreach.
• Coordinate IDT appointments for further assessments.
• Participate in case management and provide nursing consultation.
• Maintain knowledge of Medicare/Medicaid guidelines for PACE.
• Share responsibility for PACE implementation and goals.
• Supervise Eligibility RNs and scheduling.

Education

Associates degree in nursing

RN license

First Aid certification

BLS certification

Job description

Under the direction of the Director, the Manager works together with Eligibility RNs, Business Development Representatives and Enrollment Representatives in order to determine the eligibility of future participants for the InnovAge PACE Program. Physical attendance at an InnovAge facility and/or an InnovAge participant home is essential to performing the job duties.

Functional Category: Management Administration

Estimated Percent of time Spent – 70%

• Works closely with the Sales and Enrollment team to determine if prospective PACE participants meet required eligibility standards for all PACE participants.
• Oversees services related to home visits and/or center-based clinic appointments, to make level of care assessments to determine eligibility.
• Oversees completion of eligibility referral documents and completion of supporting documentation for application to the State for enrollment of potential PACE participant.
• Works closely with individual state Medicaid Departments and sales and enrollment teams to make eligibility decisions about prospective new PACE participants.
• Supports business development and census growth process by collaborating with Sales and Enrollment department, Participates and assists with outreach programs as requested and appropriate
• Serve as member of the Interdisciplinary Team (IDT), and coordinate appointments for prospects that require further assessments by other IDT members.
• Participates in the case management of peer review of client records and provides consultation to case managers and other staff members regarding medical and nursing issues.
• Maintain knowledge and expertise in eligibility, enrollment, and program specifications for the Federal and State health coverage programs Medicare and Medicaid, and specifically as those guidelines apply to the Program of All Inclusive Care for the Elderly (PACE).
• Shares responsibility with other team members in the implementation of PACE philosophy and achievement of program goals.

Functional Category: Supervision

Estimated Percent of time Spent – 30%

• Effectivelysupervises and manages direct reports and provides, by example and leadership, motivation and direction to employees of the organization.

• Oversees locally based Eligibility RNs who complete in home and phone-based eligibility assessments of potential PACE participants.

• Monitors, manages, and continually improves Eligibility RN scheduling, productivity, assessments, presentation of information within IDT & HSD meetings within respective centers.
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable state and federal employment laws.
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; recognizing and rewarding employees; corrective disciplinary procedures and practices (under direction of supervisor and in partnership with Human Resources), addressing complaints and resolving problems.
• Ensures annual employee performance reviews are conducted in a timely and effective manner. Evaluates performance of employees for compliance with established policies and objectives of the organization and contributions in attaining objectives.
• Helps set the tone of the department to ensure morale, team work, and that the positive employment culture of the organization is maintained.
• Regularly schedules leadership/management, department, and staff 1:1 meetings to provide leadership, development, and a forum for communication to ensure coordination and collaboration in meeting organization and individual goals.

Travel Requirements

Travel

• Travel required
• Overnight travel out of state

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

REQUIRED

Education

• Associates degree from accredited nursing school required
• Current Registered Nurses License in state in which working
• Current First Aid and BLS certifications are required prior to hire. Acceptable vendors for certifications are from either American Heart Association and/or American Red Cross.

Work Experience and Qualifications

• 8+ years health care experience with emphasis in geriatrics
• 1+ year working with the frail or elderly

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

Applicants are considered until the position is filled.

$103,300 - $134,400

Compensation Disclaimer

The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.

Attention Florida Applicants

This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.
For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com

Fraud Disclaimer

InnovAge is committed to maintaining a safe, transparent, and respectful hiring process for all candidates.

Please be aware that all legitimate email communication regarding InnovAge job opportunities will come exclusively from an email address ending in @innovage.com.

At no point in our hiring process will InnovAge:
Request payment from candidates for equipment, background checks, onboarding, training, or any other employment-related purpose
Ask for financial information (such as bank account details) before a formal offer and onboarding process is completed through our official systems

If you receive a message claiming to represent InnovAge that does not align with the above, it may be fraudulent. We encourage you to exercise caution and refrain from engaging or sharing personal information.

If you believe you have been contacted by someone misrepresenting InnovAge, please report the activity to [e-mail] or apply directly through our official career site to ensure the opportunity is legitimate.

Your trust matters to us, and we appreciate your interest in joining InnovAge.