Clinical Documentation Reviewer, RN

About the role

The Central Enrollment RN Reviewer plays an important role in supporting the centralized enrollment review and eligibility requirement determination process. Reporting into Central ERD leadership, this position is accountable for conducting clinical reviews of prospective participant enrollment documentation to support consistent, accurate, compliant, and timely enrollment determinations across WelbeHealth markets.

This role is different because the Central Enrollment RN Reviewer at WelbeHealth:

• Operates in a fully remote role that encourages flexibility and balance
• Reviews a managed weekly documentation volume, enabling thorough and high-quality assessments
• Plays a critical role in supporting a growing, mission-driven healthcare organization, ensuring vulnerable seniors feel supported and have access to high-quality care

Responsibilities

• Conduct clinical review of Level of Care assessments, enrollment documentation, tracker information, and supporting records to evaluate prospective participant readiness for centralized enrollment review
• Utilize approved Central ERD criteria, organizational guidelines, professional nursing judgment, and knowledge of state-specific regulatory requirements to drive consistent, compliant, and standardized enrollment recommendations and determinations across assigned markets
• Identify medical, functional, psychosocial, behavioral health, cognitive, housing, home safety, and operational considerations that may require additional review, follow-up, or interdisciplinary coordination
• Identify cases requiring escalation or additional evaluation by Medical Directors, Executive Directors, PMHNPs, Social Workers, Pharmacists, Home Care team members, Facilities or delegates, Compliance team members, or other applicable stakeholders
• Document review findings, classification considerations, follow-up needs, recommendations, and decision-support notes in a timely and accurate manner in required systems, including Excel trackers, electronic health record systems, and other designated platforms
• Participate in Central ERD meetings, case review discussions, and related process cadence to support timely enrollment decisions and appropriate operational handoff
• Communicate clearly and professionally with Enrollment RNs, MOE team members, market leaders, clinical stakeholders, and Central ERD leadership regarding review findings, documentation gaps, and participant readiness considerations

Job Requirements

• Active, unrestricted Registered Nurse (RN) license in good standing required
• Minimum of three (3) years of PACE experience
• PACE managed care, utilization review, care coordination, quality review, or regulatory healthcare experience required
• Demonstrated experience reviewing clinical documentation, conducting clinical assessments, supporting case reviews, or coordinating care across interdisciplinary teams
• Strong clinical judgment, critical thinking, and ability to identify potential participant safety, care coordination, and operational risks
• Experience using Excel, Word, Teams, electronic health records, enrollment trackers, clinical documentation platforms, or other healthcare systems preferred

We are seeking a Central Enrollment RN Reviewer that ideally has three (3) years of PACE experience. If you're ready to join a team that values both its participants and team members, we'd love to hear from you!

Benefits

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay and bonus
• And additional benefits!

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

Pay

$99,309.58—$131,088.64 USD

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.