The Enrollment Coordinator is responsible for coordinating efforts with eligibility, intake and outreach in the designated regions for Prime Care Coordination (PCC). The Enrollment Coordinator is will provide outreach in the community and assist individuals requesting enrollment into a CCO/HH. The Enrollment Coordinator will work with the local DDRO on the eligibility requirements. The Enrollment Coordinator will also lead the intake process to ensure that once the individual has chosen PCC they are able to enroll in a timely manner. Under the direction of the Director of Enrollment, the Enrollment Coordinator will support the strategic direction and goals for all aspects of eligibility, intake, and outreach for the CCO/HH that aligns with long term vision and goals of the I/DD service delivery system transformation to managed care.
Essential Job Functions:
- Responsible for the implementation of eligibility, intake, and outreach policies and procedures.
- Oversee enrollment activity and tracking for assigned regions.
- Responsible for data tracking and requirements for enrollment (Choices, TABS, MAPP, etc.)
- Follow regulatory requirements for eligibility per OPWDD standards including Medicaid approval.
- Assist with the effort to develop, implement, and report outreach plans for PCC in coordination with regional hub and leadership staff.
- Promote collaboration with Quality Management services to monitor the quality management plan and compliance issues pertaining to Care Coordination eligibility and intake process.
- Conduct program evaluation and quality improvement activities in the enrollment of Care Coordination service delivery.
- Prepare reports as required by the Director of Enrollment.
- Assist with the coordination and networking with other organizations, agencies, and service providers within the region to foster community partnership in addressing the needs of individuals and families.
- Provide case load coverage as requested.
- Perform all other duties relevant to the position as requested.
Knowledge, Skills, and Abilities:
- Ability to quickly establish and maintain leadership credibility with key stakeholders.
- Knowledge of OPWDD and/or DOH program and service delivery system and regulations
- Must be able to multi-task, establish priorities, and meet deadlines.
- Ability to work independently and motivate others.
- Ability to communicate effectively, both orally and in writing.
- Ability to act quickly, assess and act accordingly in crisis situations
Education and Experience:
- Bachelor’s degree with two years of relevant experience OR
- A license as a Registered Nurse with two years of relevant experience, which can include any employment experience and is not limited to case management/service coordination duties OR
- A Master’s degree with one year of relevant experience.
Physical Requirements/Working Conditions:
- Ability to sit/stand throughout day to accomplish job
- Ability to enter data, notes, and other documentation into a computer.
- Must be able to travel throughout covered territories in Upstate NY as needed.
- Adhere to all Prime Care Coordination policies and procedures.
- Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards.
- Attend mandatory education and training modules as scheduled; obtain and maintain required certifications.
- Maintain all required certifications/training by State regulations and PCC policy
- Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication, language, and dress.