Medicaid Eligibility Manager

One Senior Care; United States; Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

9 Paid Holidays

PTO 3 weeks + 1 day per year

Life and AD&D Insurance

Health Savings and Flexible Spending

Short Term Disability

Group Term Life Insurance for Employee

Tuition Reimbursement and PaidTraining

Retirement Plan with company match

Mileage Reimbursement

Job summary

One Senior Care is hiring a Medicaid Eligibility Specialist to ensure eligibility is established and maintained for participants in the PACE program. You will manage transitions from intake to enrollment and renewals, coordinating with county offices to keep access to services uninterrupted.

This role suits detail-oriented, process-driven individuals who work well independently yet collaborate with internal teams. Prior Medicaid/PACE exposure is preferred and training is provided.

Qualifications

• High school diploma or equivalent required.
• Knowledge of Medicaid, Medicare, and PACE eligibility regulations preferred.
• At least one year of experience working with the frail or elderly population, or willingness to complete extensive training.
• Experience using electronic records or case management systems is a plus.

Responsibilities

• Manage Medicaid eligibility from intake to enrollment and renewals for participants.
• Monitor eligibility for pending and presumptive enrollees and respond to information requests from county offices.
• Track and manage Medicaid renewals and revalidations using established workflows and timelines.
• Support the appeals process on behalf of participants when needed.
• Coordinate with county offices and internal teams to ensure documentation is received and submitted accurately.
• Communicate changes in participant Medicaid status and policy updates to internal teams.

Skills

Detail-oriented

Process-driven

Organized

Independent work

Medicaid knowledge

Education

High school diploma

Tools

Case management systems

Job description

Are you motivated by helping ensure people receive the services they depend on?

Are you someone who values accuracy, consistency, and supporting others through reliable processes?

If so, you may be the perfect fit for our One Senior Care family of businesses - including LIFE-NWPA, Mountain View PACE, and Buckeye PACE.

Job Summary:

As a Medicaid Eligibility Specialist, you'll play a critical role in supporting seniors by ensuring their Medicaid eligibility is established and maintained throughout their enrollment in the PACE program. You'll manage eligibility processes from initial enrollment through ongoing renewals, helping participants maintain uninterrupted access to care and services.

This position is ideal for someone who values precision, follows established procedures closely, and takes pride in producing accurate, high-quality work. You'll work at a steady, predictable pace, primarily independently, while providing reliable support to internal teams and external partners.

Schedule:

First shift, full-time hours. Specific work hours will be established in consultation with your supervisor.

• 9 Paid Holidays
• PTO starting at 3 weeks + 1 day per year (accrued from date of hire for full-time employees)
• Free Life and AD&D Insurance Plan
• Health Savings and Flexible Spending Accounts
• Short Term Disability Insurance
• Group Voluntary Term Life Insurance for Employee, Spouses, and Dependents
• Tuition Reimbursement and Paid Training Opportunities
• Retirement Plan with company annual match
• Mileage Reimbursement at annual IRS rate as applicable

Duties/Responsibilities:

• Manage the transition of Medicaid applications from intake teams to ensure eligibility is established for newly enrolled Participants.
• Monitor eligibility for pending and presumptive enrollees and respond promptly to county requests for information.
• Track and manage Medicaid renewals and revalidations using established workflows and timelines.
• Support the appeals process on behalf of Participants when needed.
• Coordinate with county offices and internal teams to ensure required documentation is received and submitted accurately.
• Respond timely to any changes in participant Medicaid Status.
• Conduct ongoing monitoring of eligibility, including annual and situational redeterminations.
• Communicate clearly with internal teams regarding eligibility status, renewal deadlines, documentation needs, and policy changes that could impact their access to services.
• Build and maintain professional relationships with county offices to support timely issue resolution.

Everyone's journey is unique. Even if you haven't done it all, your dedication to learning and helping others is what counts. With our training, mentorship, and career development programs, we'll help you grow and succeed.

What Makes You a Great Fit:

• Highly detail-oriented with a strong focus on accuracy and consistency.
• Comfortable following clearly defined processes and procedures.
• Patient, conscientious, and able to double-check work to ensure quality results.
• Organized and dependable, with the ability to manage repetitive tasks effectively.
• Professional, polite, and service-oriented in all interactions.
• Able to work independently while collaborating as needed with internal partners.

Education and Experience:

• High school diploma or equivalent required.
• Knowledge of Medicaid, Medicare, and PACE eligibility regulations preferred.
• At least one year of experience working with the frail or elderly population, or willingness to complete extensive training.
• Experience using electronic records or case management systems is a plus.

Physical Requirements:

• Ability to move intermittently throughout the workday.
• Ability to sit, stand, bend, and lift as needed.
• Must be able to drive a motor vehicle.
• Ability to travel locally and regionally, with occasional overnight travel.

Join Us!

At One Senior Care, you'll be part of a compassionate team that makes a tangible difference in seniors' lives - working together to keep participants safe, healthy, connected, and at home.

One Senior Care is an Equal Opportunity Employer. Employment is contingent upon successful completion of required background checks, health and safety screenings, and any clearances required for healthcare programs.