Central Pre-Enrollment Provider Nurse Practitioner

Role Scope

We are looking for a clinically outstanding and detail-oriented Nurse Practitioner or Physician Assistant to join our centralized Pre-Enrollment team. This role reports directly to the Chief Medical Officer, with a dotted-line relationship to the Pre-Enrollment Director. You will serve as the clinical backbone of our chart review process, working hand in hand with Site Medical Directors across all Habitat Health PACE locations to ensure every case is thoroughly evaluated for PACE eligibility and Health & Safety (H&S) considerations before enrollment.

Core Responsibilities & Expectations

• Conduct thorough and complete chart reviews for PACE applicants, evaluating medical records, diagnostic history, functional status, and clinical documentation to capture all factors relevant to eligibility determination and potential H&S denial.
• Present cases to Site Medical Directors as needed based on departmental guidelines and policy, ensuring all clinical findings are clearly communicated to support informed eligibility decisions.
• Collaborate closely with Enrollment RNs (ERNs) and Site Medical Directors to ensure documentation gaps are identified and resolved prior to submission; serve as the escalation point when ERNs are unable to obtain required diagnostic information.
• Provide clinical expertise for Health & Safety determinations, including participation in H&S Committee meetings; when chart review reveals diagnostic gaps that cannot be resolved by the ERN, conduct virtual clinical assessments to obtain or confirm required diagnoses and ensure chart completeness prior to submission.
• Review ILOC clinical summaries to ensure clear connections between medical conditions, functional limitations, and PACE services are documented to regulatory standard.
• Support quality improvement initiatives aimed at maintaining high first-pass DHCS approval rates and reducing documentation deficiencies.
• Serve as a clinical resource for the Pre-Enrollment team on complex cases, supporting accuracy and thoroughness in ILOC documentation to protect the organization's H&S denial integrity.