Central Pre-Enrollment Provider Nurse Practitioner

About the role

We are looking for a clinically outstanding clinician 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.

Responsibilities

• 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

California NP practice note

Nurse Practitioners at Habitat Health PACE practice collaboratively with Site Medical Directors and the CMO in accordance with California Business and Professions Code 2746 and AB 890 provisions. This role operates within a collaborative physician-NP model consistent with Habitat Health PACE's interdisciplinary care framework.

Requirements

• 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

Preferred 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 is a plus
• Proficiency with telehealth and virtual assessment methodologies, including 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

Pay

The anticipated base salary range for this position is $116,000 - $152,000. This position is also eligible for a target annual bonus of 10% and may be eligible for additional incentive compensation, as applicable. The final compensation offered will be determined based on factors including, but not limited to, the candidate's qualifications, skills, experience, education, certifications, geographical location, and business needs.

Benefits

This position is eligible for a comprehensive benefits package, including medical, dental, and vision insurance; paid parental leave, short- and long-term disability coverage; life insurance; flexible spending accounts; a 401(k) savings plan that includes a match; paid time off; and company paid holidays.

Schedule

Estimated Start Date: 9/8/2026. Location: Remote.