Central Pre-Enrollment Provider Nurse Practitioner
$133,000–$152,000 year
RemoteUnited States
Job Summary
Conduct thorough chart reviews for PACE applicants, evaluating medical records, diagnostic history, and functional status to determine eligibility and identify Health & Safety denial factors. Present clinical findings to Site Medical Directors and collaborate with Enrollment RNs to resolve documentation gaps before submission. Provide clinical expertise for Health & Safety determinations, including participation in committee meetings and virtual assessments when diagnostic information is missing. Review ILOC clinical summaries to ensure regulatory compliance and support quality improvement initiatives aimed at maintaining high first-pass approval rates. Serve as the clinical backbone of the centralized Pre-Enrollment team, working directly with the Chief Medical Officer and Site Medical Directors across all locations.
Required Qualifications
- Current, unrestricted Nurse Practitioner (NP) or Physician Assistant (PA) license in California
- Current DEA certification and furnishing/prescriptive authority in California
- Minimum 3 years of post-licensure NP clinical experience in geriatrics, long-term care, or PACE-adjacent setting
- Demonstrated chart review proficiency: ability to capture all factors relevant to PACE eligibility and H&S denial determinations
- Competency with geriatric assessment tools: BIMS, PHQ-9, MoCA, MMSE, ADL/IADL scales
- Strong ILOC documentation skills meeting California Title 22 and 42 CFR Part 460 standards
- Proficiency with Epic EHR and Microsoft Outlook; ability to manage high-volume time-sensitive communication in a fast-paced department
- Experience working in interdisciplinary team environments with physicians, RNs, and social workers
- Understanding of CMS and DHCS regulations related to PACE eligibility and NFLOC criteria
- Ability to practice collaboratively with Habitat Health PACE Site Medical Directors across multiple California sites
- Experience presenting complex cases to Medical Directors in a fast-paced clinical environment
- Cultural competence and experience working with diverse elderly populations
- Willingness to conduct virtual clinical assessments when diagnostic gaps require direct provider evaluation
- Familiarity with DHCS ILOC submission process and Health & Safety committee frameworks
- Knowledge of behavioral health assessment in geriatric populations
- Experience with care transitions between different levels of care
- Adult-Gerontology Primary Care Nurse Practitioner population focus preferred, or active pursuit of certification
- Adult-Gerontology Acute Care Nurse Practitioner (AGPCNP) population focus preferred, or active pursuit of certification
- Bilingual Spanish/English — strongly preferred
- Willingness to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role and work location
Desired Qualifications
- Previous experience in PACE or similar programs serving older adults with complex needs
- Prior experience in a lead clinical role or informal leadership capacity
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