Director, RN Eligibility

InnovAge • Full-time • Denver, Colorado • 2w ago

Ideally would prefer for this individual to be located in our corporate office in Denver, CO but will consider elsewhere, specifically CA

Under the direction of the Vice President, the Director 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.

Essential Functions and Work Responsibilities

Functional Category: Management Administration

Estimated Percent of time Spent – 70%

Works closely with the Business Development and Enrollment Department to determine if prospective PACE participants meet Guidelines required 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 assessments and supporting documentation for application to the State for PACE enrollment.
Works closely with the sales and enrollment teams and interfaces with state specific departments, as needed, to make eligibility decisions about prospective new PACE participants.
Supports business development and census growth process by collaborating and working side-by-side with sales and enrollment.. Participates and assists with outreach programs as requesrted and appropriate.
Participates in the case management of peer review of client records and provides consultation to case managers, within HSD, and for 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.
Directs the resolution of highly complex or unusual business problems applying advance analytical thought and judgement
Requires comprehensive understanding of internal and industry standards, as well as of the changing business environment
Applies industry expertise and awareness to drive financial and operational performance within an area or multiple related areas

Functional Category: Supervision

Estimated Percent of time Spent – 30%

Leads through subordinate managers; executes sub-functional/sub-regional strategy. Effectively supervises and manages direct reports and provides, by example and leadership, motivation and direction to employees of the organization.
Carries out supervisory responsibilities in accordance with the organization's policies and applicable state and federal employment laws.
Supports review and continuous improvement of manager and Eligibility RN assessments and work with a focus on driving continually improved outcomes in clinical skill, documentation, and interpersonal skills within IDT, center, and HSD communication and relationships.
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 50-75%
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 certification are American Heart Association and Red Cross

Work Experience and Qualifications

10+ years health care experience with emphasis in geriatrics
3+ 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.

Salary Range Minimum

USD $136,400.00/Yr.
Salary Range Maximum

USD $177,400.00/Yr.

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