Responsibilities

• Develop and execute the annual PACE marketing and enrollment plan in alignment with organizational growth objectives, enrollment capacity, geographic service area, and operational capabilities.
• Translate organizational enrollment goals into measurable marketing, referral development, and enrollment activities.
• Develop targeted strategies to increase awareness and understanding of the PACE model among prospective participants, caregivers, healthcare providers, and community stakeholders.
• Recommend adjustments to marketing strategies based on enrollment performance, referral patterns, market conditions, and organizational capacity.
• Establish productive relationships with hospitals, physician practices, health systems, skilled nursing facilities, home health agencies, senior living organizations, social service agencies, and other potential referral partners.
• Educate referral partners regarding the PACE model, participant eligibility, services, referral procedures, and populations most likely to benefit from the program.
• Coordinate with clinical, social services, financial eligibility, transportation, intake, and other PACE functions necessary to complete the enrollment process.
• Identify and resolve operational barriers contributing to enrollment delays or participant attrition.
• Ensure enrollment documentation is completed accurately and maintained according to organizational and regulatory requirements.
• Ensure prospective participants and their representatives receive accurate information regarding the PACE program, eligibility requirements, services, participant responsibilities, and enrollment process necessary to make informed enrollment decisions.

Requirements

• Strong understanding of the Medicare/Medicaid dual-eligible population and the financial, clinical, social, and administrative factors that can affect enrollment.
• Knowledge of PACE eligibility and enrollment concepts and the ability to effectively explain the PACE model to prospective participants, caregivers, referral partners, and community stakeholders.
• Working knowledge of Medicare, Medicaid, managed care, and government-sponsored healthcare enrollment processes.
• Ability to identify and resolve barriers that can delay or prevent enrollment, including eligibility, documentation, participant decision-making, and coordination with external agencies.
• Understanding of the differences between traditional Medicare/Medicaid coverage, managed care arrangements, and the integrated model of care provided through PACE.
• Experience using CRM, enrollment, eligibility, or member-management systems to manage prospective participants through a multi-stage enrollment process.
• Ability to maintain confidentiality and exercise appropriate judgment when handling sensitive participant information.
• Progressively responsible experience in healthcare enrollment, marketing, business development, intake, member acquisition, or referral development.
• Proven success in managing or directly supporting the enrollment of Medicare/Medicaid dual-eligible individuals into PACE, managed care, or other government-sponsored healthcare programs.
• Demonstrated experience managing an enrollment pipeline from initial lead/referral through eligibility determination and completed enrollment.