PACE Clinical Enrollment RN Manager

At Habitat Health, we envision a world where older adults experience an independent and joyful aging journey in the comfort of their homes, enabled by access to comprehensive health care. Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. 

Habitat Health offers a fully integrated experience that brings more good days and a sense of belonging to participants and their caregivers. We build engaged, fulfilled care teams to deliver personalized care in our centers and in the home. And we support our partners with scalable solutions to meet the health care needs and costs of aging populations. 
 
Habitat Health is growing, and we’re looking for new team members who wish to join our mission of redefining aging in place. To learn more, visit https://www.habitathealth.com. 

Role Scope: 

Lead clinical assessment and eligibility determination processes for PACE program enrollment. Manage multidisciplinary teams including RN Supervisors, RNs, and social workers to ensure regulatory compliance with DHCS requirements while achieving quality outcomes and operational efficiency targets. Drive measurable improvements in approval rates, processing times, and team performance. 

Clinical Operations Management (40%) 

- Oversee comprehensive clinical assessments and Initial Level of Care (ILOC) determinations for PACE eligibility 

- Lead multidisciplinary assessment teams including RNs, MSWs, and support staff 

- Review and approve complex eligibility cases requiring specialized clinical judgment 

- Coordinate Health & Safety and Behavioral Health committee processes 

- Ensure clinical assessments meet nursing facility level of care standards 

Regulatory Compliance & Quality Assurance (30%) 

-  Serve as primary liaison with DHCS for eligibility determinations and regulatory submissions 

- Ensure compliance with 42 CFR Part 460 PACE program regulations and state requirements 

- Implement and maintain quality review processes for all clinical documentation 

- Manage resubmission processes for deferred or denied applications 

- Develop and implement corrective action plans for regulatory compliance issues 

Team Leadership & Staff Development (20%) 

- Supervise pre-enrollment clinical staff including performance management 

- Conduct team meetings and provide regulatory training 

- Ensure adequate staffing coverage and resource allocation 

- Mentor staff and support professional development initiatives 

- Foster collaborative multidisciplinary team relationships 

Strategic Planning & Process Improvement (10%) 

- Optimize pre-enrollment workflows to improve processing efficiency 

- Monitor KPIs including approval rates, processing times, and quality metrics 

- Lead continuous improvement initiatives 

- Participate in organizational strategic planning for enrollment capacity 

- Provide clinical expertise to senior leadership 

Qualifications:  

• Bachelor's degree in Nursing (BSN) required 

• Master's degree in Nursing, Healthcare Administration, or related field preferred 

• Current unrestricted Registered Nurse license 

• Minimum 2 years clinical nursing experience in complex healthcare settings 

• Minimum 1 years supervisory or management experience 

• Experience with regulatory compliance in Medicare/Medicaid programs 

• PACE program experience preferred 

• Experience with clinical assessment and eligibility determinations 

• Proficiency with Epic electronic health record system 

• Experience working in interdisciplinary team environments 

• Understanding of CMS and DHCS regulations related to PACE behavioral health services and Health and Safety requirements 

• Nice to have: 

• Expert knowledge of nursing assessment and clinical documentation standards 

• Strong understanding of PACE regulations and DHCS requirements 

• Proficiency in EHR systems and clinical documentation platforms 

• Advanced analytical and problem-solving skills 

• Excellent written and verbal communication skills 

• Leadership and team management capabilities 

• Quality improvement and process optimization experience 

• Previous experience in PACE or similar programs serving older adults with complex needs 

• Familiarity with Health and Safety regulations for community-based care programs 

• Familiarity with community-based long-term care services and supports 

• Experience with capacity evaluations and working with adults with cognitive impairment 

• Bilingual skills (particularly Spanish/English) 

Compensation:  

We take into account an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $120,000 -$140,000 annually. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. 

Vaccination Policy, including COVID-19  

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe and essential requirement of this role.  Requests for reasonable accommodation due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment. 

Our Commitment to Diversity, Equity, and Inclusion: 

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. 

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law.  Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at careers@habitathealth.com. 

E-Verify Participation Notice  

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.  If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment.  Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9. 

Beware of Scams and Fraud 

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/.