17:I[59529,["/_next/static/immutable/chunks/2corl6wyj4669.js","/_next/static/immutable/chunks/31r--0f39g9ze.js","/_next/static/immutable/chunks/0ecdjrtw9-w3j.js","/_next/static/immutable/chunks/1nbyhb2cfdaol.js","/_next/static/immutable/chunks/1hodejexxhw_x.js","/_next/static/immutable/chunks/39f9_79wvgc2y.js"],"default"] 18:Tc96,Overview

6 months Contract / Temp - with extensionAbout us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief of Summary of Purpose:

Responsible for processing, verifying, and reconciling Accounts Payable invoices.

Responsibilities

Primary Job Responsibilities:

AP processing for FCHP and overall functionality of Oracle AP
Enter/Scan all accounts payable invoices into Oracle and analyze and pay vendor accounts according to invoice terms, either PO or GL account costing
Ensure AP invoice and backup approvals attached to payment
Assist with AP inquires
Assist with incoming mail, distribute accordingly
Upload other multi line AP requests into Oracle Financials / Record all ACH/Wire payments
Submits payment to bank, confirms positive pay
Assist with requests from Internal Audit with Model Audit requests
Assist the Director of accounting Operations with ad hoc projects

Qualifications Education:

Associate degree in accounting or equivalent work experience.

Experience:

1-2 Years’ experience working in an accounting dept- specific Accounts Payable processing preferred.

Pay Range Disclosure:In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 55,000 which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

19:T1869,Overview

Fantastic Call Center Opportunities with training, career path advancement, great benefits, paid time off, heath insurance and more..

*The REMOTE work model can commence after approximately 8-9 weeks of on-site training in Worcester, MA. Must be able to type 25 WPM net.

Many day shifts are available and are discussed during the interview process.

The Great Opportunity:

It’s an exciting time to join Fallon Health as we experience growth and expansion with new services and products. There are many great opportunities within our organization starting with joining our Member Services team. Member Services offers a very unique opportunity to interact with nearly every facet of the Fallon Health organization including our products, services, functions, and people.

Among the most rewarding and fulfilling parts of working on this team is representing Fallon Health as the face of the organization; the single point of contact for our valued providers and members. Think of yourself as an Fallon brand and membership ambassador. As a representative of Fallon Health, you will be an advocate to members reaching out for support; providing this highly valued service fielding calls and constitutively troubleshooting inquiries, you will be solving their needs and concerns.

In addition to the diverse responsibilities outlined below, a spot on this team also represents one of the best places to grow your career. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions and endless opportunities for advancement. Member Services has proven to be a launching pad of development that has translated into long term careers with advancement opportunities throughout the company in a number of different key area’s such as; Sales and Marketing, Provider Relations, Care Services, Pharmacy and other functions of the operation.

As a brand champion and valued member ambassador you will get extensive training and support through a skill based progression training program that includes a blended learning curriculum and personalized coaching plan. We are always looking for top talent in these roles so feel free to pass this along to friends, family and colleagues that you think qualify.

Responsibilities

Position Overview:

The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health's 1-800 numbers, as well as providing direction on Plan policies, procedures, and benefits.

Some key responsibilities include:

Ownership for development of knowledge and skills, as training program provides material and framework for success.
Ownership for customer satisfaction. Member Service Representatives are the primary liaison for our members to obtain the information or support they need As such, our representatives are expected to fully understand member/ provider needs, and within corporate/ department policies, take whatever action is necessary to fully satisfy the inquiry.
Clear and concise documentation of call detail for tracking of member/ provider contacts.
Identification and communication of trends that are indicative of enterprise service issues.
Escalation of member/provider concerns and servicing issues.
Appropriate execution of corporate and department policies/ practices.

Qualifications

High school diploma or GED is preferred but we would consider relevant customer service call center work experience in lieu of this.
Bachelor’s degree or advanced education is also preferred but not required.
2+ years professional work experience preferably in a customer facing inbound call-center setting
The ability to multitask and leverage strong typing skills and a high proficiency with MS Word, MS Excel and system data entry are essential tools for success in this role

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay rate for this position is $22 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting.

#P02

1a:T1947,Overview

About us:

Brief summary of purpose:

The RN Nurse Case Manager (NCM) is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for NaviCare members. The NCM seeks to establish face-to-face and telephonic relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the NCM and Care Team. Responsibilities may include conducting in-house face-to-face visits for members identified as needing face-to-face visit interaction and care planning with the goal of coordinating and facilitating services to meet member needs according to benefit structures and available community resources. NCMs are responsible for completing all Transition of Care Assessments, which may be done both in person and telephonically. The NCM is responsible for reconciling all medications at time of transition. The NCM creates all initial care plans, updates care plans as needed and executes care planning activities for medically complex members. The NCM collaborates with Navigators on the care of all members to address medical concerns and to provide holistic and comprehensive case management.

Responsibilities

Primary Job Responsibilities

Member Assessment, Education, and Advocacy

Assess and manage a member panel through in-person and telephonic outreach.
Complete medication reconciliations and care transition assessments.
Educate members on benefits, rights, disease management, medications, and preventive screenings. Ensure members and authorized representatives participate in and approve care plans.
Support member self-management through coaching and health education.

Care Coordination and Collaboration

Develop and update individualized care plans based on assessments.
Coordinate services and authorize care according to program and regulatory standards.
Collaborate with Navigators, PCPs, Behavioral Health Case Managers, pharmacists, and community partners.
Track progress toward goals and adjust care plans as needed.
Participate in interdisciplinary rounds and team communication.
Build strong relationships with members, caregivers, and providers for coordinated, culturally appropriate care.

Regulatory Requirements – Actions and Oversight
- Complete assessments, screenings, notes, and care plans within regulatory timelines.
- Follow HIPAA and organizational confidentiality policies.
- Support HEDIS, Medicare 5-Star, and quality initiatives through outreach and education.
- Assist with departmental campaigns, projects, and coverage as assigned.

Qualifications Education

RNs: Graduate from an accredited school of nursing, associate’s degree required, bachelor’s or higher preferred

License/Certifications

License: RN Candidates (Required) Active, unrestricted license as a Registered Nurse in Massachusetts

Certification: Certification in Case Management strongly desired, willingness to obtain when eligible

Other: Driving your personal motor vehicle is an essential job function for this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Experience

1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
Ability to conduct assessments in-person and telehealth.
Ability to work on interdisciplinary teams.
Skill in screening social determinants of health.
Strong communication and interviewing skills. Problem-solving skills and adaptability.
Knowledge or willingness to learn regulatory requirements.
Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.
Reliable home internet.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is around $95,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

1b:T1ea6,Overview

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?..

+ *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work.

+ Mileage Reimbursement!

+ Respectful and Desirable Health Aide / CNA Work Setting!

Predictable Hours!
Safe and highly vaccinated work environment including the member population you care for
Our Health Aides and staff love the familiarity and relationships establishes with our members
You will likely find more autonomy and flexibility than you have in your current role
Our model is low-volume and very member and quality care focused

About us:

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region.

Summary:

Provides personal care, light housekeeping, and assistance with ADLs (Activities of Daily Living) as outlined in each Summit Eldercare participant’s plan of care in participant homes as well as at the PACE center; exercises independent judgement; reports any changes in participant status to the IDT; participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines

Responsibilities

Primary Job Responsibilities

Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants’ homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.)
Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team.
Collaborate with members of the Interdisciplinary Team to assure appropriateness and continuity of care.
Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community.
Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants’ motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness.
Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises.
Maintains a clean and safe working and/or living environment in the PACE center and/or participants’ homes.
Assists with meal and snack preparation, serving, feeding as needed, and clean-up.
Uses safe techniques in all interactions with participants at the PACE Center and in participants’ homes.
Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor.
Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions
Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned.
Actively participates in regular team meetings for health aides at respective site.
Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines.
Performs all duties in accordance with FH and Summit ElderCare policies and procedures.

Qualifications

Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate.

Certification:

Certification as a Home Health Aide or Nursing Assistant is desired.

Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

Experience:

One year of experience working with a frail and/or older adult population preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently.
Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $20.00 to $24.00 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

1c:T1ea5,Overview

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?..

+ *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work.

+ Mileage Reimbursement!

+ Respectful and Desirable Health Aide / CNA Work Setting!

Predictable Hours!
Safe and highly vaccinated work environment including the member population you care for
Our Health Aides and staff love the familiarity and relationships establishes with our members
You will likely find more autonomy and flexibility than you have in your current role
Our model is low-volume and very member and quality care focused

About us:

Summary:

Responsibilities

Primary Job Responsibilites

Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants’ homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.)
Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team.
Collaborate with members of the Interdisciplinary Team to assure appropriateness and continuity of care.
Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community.
Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants’ motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness.
Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises.
Maintains a clean and safe working and/or living environment in the PACE center and/or participants’ homes.
Assists with meal and snack preparation, serving, feeding as needed, and clean-up.
Uses safe techniques in all interactions with participants at the PACE Center and in participants’ homes.
Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor.
Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions
Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned.
Actively participates in regular team meetings for health aides at respective site.
Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines.
Performs all duties in accordance with FH and Summit ElderCare policies and procedures.

Qualifications

Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate.

Certification:

Certification as a Home Health Aide or Nursing Assistant is desired.

Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

Experience:

One year of experience working with a frail and/or older adult population preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently.
Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $20.00 to $24.00 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

1d:T1ea6,Overview

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?..

+ *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work.

+ Mileage Reimbursement!

+ Respectful and Desirable Health Aide / CNA Work Setting!

Predictable Hours!
Safe and highly vaccinated work environment including the member population you care for
Our Health Aides and staff love the familiarity and relationships establishes with our members
You will likely find more autonomy and flexibility than you have in your current role
Our model is low-volume and very member and quality care focused

About us:

Summary:

Responsibilities

Primary Job Responsibilities

Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants’ homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.)
Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team.
Collaborate with members of the Interdisciplinary Team to assure appropriateness and continuity of care.
Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community.
Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants’ motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness.
Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises.
Maintains a clean and safe working and/or living environment in the PACE center and/or participants’ homes.
Assists with meal and snack preparation, serving, feeding as needed, and clean-up.
Uses safe techniques in all interactions with participants at the PACE Center and in participants’ homes.
Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor.
Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions
Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned.
Actively participates in regular team meetings for health aides at respective site.
Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines.
Performs all duties in accordance with FH and Summit ElderCare policies and procedures.

Qualifications

Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate.

Certification:

Certification as a Home Health Aide or Nursing Assistant is desired.

Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

Experience:

One year of experience working with a frail and/or older adult population preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently.
Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $20.00 to $24.00 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

1e:T1ea5,Overview

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?..

+ *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work.

+ Mileage Reimbursement!

+ Respectful and Desirable Health Aide / CNA Work Setting!

Predictable Hours!
Safe and highly vaccinated work environment including the member population you care for
Our Health Aides and staff love the familiarity and relationships establishes with our members
You will likely find more autonomy and flexibility than you have in your current role
Our model is low-volume and very member and quality care focused

About us:

Summary:

Responsibilities

Primary Job Responsibilites

Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants’ homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.)
Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team.
Collaborate with members of the Interdisciplinary Team to assure appropriateness and continuity of care.
Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community.
Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants’ motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness.
Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises.
Maintains a clean and safe working and/or living environment in the PACE center and/or participants’ homes.
Assists with meal and snack preparation, serving, feeding as needed, and clean-up.
Uses safe techniques in all interactions with participants at the PACE Center and in participants’ homes.
Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor.
Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions
Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned.
Actively participates in regular team meetings for health aides at respective site.
Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines.
Performs all duties in accordance with FH and Summit ElderCare policies and procedures.

Qualifications

Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate.

Certification:

Certification as a Home Health Aide or Nursing Assistant is desired.

Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

Experience:

One year of experience working with a frail and/or older adult population preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently.
Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $20.00 to $24.00 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

1f:T17b5,Overview

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About Summit ElderCare:

Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.

Brief summary of purpose:

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice

Competencies:

Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision.

Specific competencies essential to this position:

Customer Focus
Commitment Through Action
Contributes to Team Performance
Focus Upon Quality

Responsibilities

Primary job responsibilities:

Reviews and implements Provider’s orders.
Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and MDS-HC as indicated.
Involves participants and significant other(s) based on needs and abilities.
Delivers care to participants in any setting, including skilled services, based on individualized needs and according to age-appropriate nursing standards.
Provides for cultural and diverse needs of participants when providing care.
Monitors and evaluates therapeutic interventions.
Participates in the development and ongoing review of each participant’s care plan.
Delegates participants’ care responsibilities to other members of the health care team, when appropriate.
Identifies emergency situations and initiates appropriate nursing orders/interventions.
Meets the needs of participants in a timely manner.
Participates in the interdisciplinary team (IDT) process and collaborates with IDT members to meet the needs of participants.
Consistently documents all aspects of participant care, including significant changes in health status, monthly nurses’ notes and health care teaching in the medical record.
Participates in training and orientation of new nursing staff as assigned.
Assists in the delivery of other nursing services as assigned.
Participates in the nursing “on-call” rotation as assigned.
Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures.
Participates in Weekend RN On Call rotation

Qualifications

Education, Licenses, certification and experience requirements:

Education:

Graduate of an accredited school of nursing

License:

Current license as an RN in the state of Massachusetts

Certification:

Current CPR and Alzheimer’s certification, or willingness to be certified within 60 days of hire, is essential.

Experience:

At least two years of recent experience in the direct care of adults or chronically disabled persons, with at least one year caring for a frail or elderly population. Ambulatory care or home care experience is helpful.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the compensation for this position is $90,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P01

20:T1a1f,Overview

About us:

Brief Summary of purpose

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice.

Responsibilities

Primary Job Responsibilities

Primary nurse not only has the responsibility for the participant, but the authority to advocate for the best care for the participant unique to their situation.
Fostering a relationship with the caregiver and participant.
Primary Nurse will take on a Leadership Role.
Effectively communicate with the healthcare team.
Assigns tasks and duties to the healthcare team; ensure the tasks are completed; responsible for their panel.
Develops an individualized plan of care.
Accountability for assessments, communicating needs and coordinating the care team.
Primary nurse develops the plan of care
Reviews and implements Provider’s orders.
Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and MDS-HC as indicated.
Involves participants and significant other(s) based on needs and abilities.
Delivers care to participants in any setting, including skilled services, based on individualized needs and according to age-appropriate nursing standards.
Provides for cultural and diverse needs of participants when providing care.
Monitors and evaluates therapeutic interventions.
Delegates and or accepts participants’ care responsibilities to other members of the health care team, when appropriate.
Identifies emergency situations and initiates appropriate nursing orders/interventions.
Meets the needs of participants in a timely manner.
Participates in the interdisciplinary team (IDT) process and collaborates with IDT members to meet the needs of participants.
Consistently documents all aspects of participant care, including significant changes in health status, monthly nurses’ notes and health care teaching in the medical record.
Participates in training and orientation of new nursing staff as assigned.
Assists in the delivery of other nursing services as assigned.
Participates in the nursing “on-call” rotation as assigned.
Initiates and completes falls, infection, grievance and incident reports
Participates in CMS calls when deemed necessary.
Active participant in the site specific committees.
Participates in the post IDT huddle and any other additional meetings
Any additional tasks deemed necessary by the Clinical Nurse Manager and or Site Director.
Assumes the role of the home care nurse, floor or triage nurse per the direction of the Clinical Nurse Manager or Site Director as appropriate.
Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures.
Functions independently to administer medications and treatments as ordered by the provider. Functions independently in the primary nurse role. Independent in performing a nursing assessment and executing the plan of care in all settings the participant maybe in.
Medication administration
Performing bladder scans, EKG, Point of Care, and glucometer testing

Qualifications

Education:

Graduate of an accredited school of nursing

License/Certifications:

Current license as an RN in the state of Massachusetts
CPR and Alzheimer’s certification, or willingness to be certified within 60 days of hire, is essential.
Access to reliable transportation to perform work throughout the PACE center’s service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage

Experience:

At least two years of recent experience in the direct care of adults or chronically disabled persons with at least one year caring for a frail or elderly population. Ambulatory care or home care experience helpful.
Ability to use an electronic medical record.

Other:

Reliable Transportation Required

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the compensation for this position is $96,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P01

21:T168d,Overview

About us:

Brief summary of purpose:

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice

Competencies:

Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision.
Specific competencies essential to this position:
- Customer Focus
- Commitment Through Action
- Contributes to Team Performance
- Focus Upon Quality

Responsibilities

Primary Job Responsibilities

Reviews and implements Provider’s orders.
Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and MDS-HC as indicated.
Involves participants and significant other(s) based on needs and abilities.
Delivers care to participants in any setting, including skilled services, based on individualized needs and according to age-appropriate nursing standards.
Provides for cultural and diverse needs of participants when providing care.
Monitors and evaluates therapeutic interventions.
Participates in the development and ongoing review of each participant’s care plan.
Delegates participants’ care responsibilities to other members of the health care team, when appropriate.
Identifies emergency situations and initiates appropriate nursing orders/interventions.
Meets the needs of participants in a timely manner.
Participates in the interdisciplinary team (IDT) process and collaborates with IDT members to meet the needs of participants.
Consistently documents all aspects of participant care, including significant changes in health status, monthly nurses’ notes and health care teaching in the medical record.
Participates in training and orientation of new nursing staff as assigned.
Assists in the delivery of other nursing services as assigned.
Participates in the nursing “on-call” rotation as assigned.
Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures.
Participates in Weekend RN On Call rotation

Qualifications

Education

Graduate of an accredited school of nursing

License/Certifications

License: Current license as an RN in the state of Massachusetts
Certification: CPR and Alzheimer’s certification, or willingness to be certified within 60 days of hire, is essential.

Access to reliable transportation to perform work throughout the PACE center’s service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Experience

At least two years of recent experience in the direct care of adults or chronically disabled persons with at least one year caring for a frail or elderly population. Ambulatory care or home care experience helpful.

Pay Range Disclosure:In accordance with the Massachusetts Wage Transparency Act, the pay for this position is budgeted for $ $37.00 per hour for LPN - and - $90,000 annually for RN - which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P01

22:T1f4c,Overview

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?..

+ Great benefits!

Full-time benefits offering!
Health Insurance offerings!
Paid Time Off!
12 Holidays!
401K Savings Plan!
Tuition Assistance!
Vision Care, Life Insurance and more!!

+ *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work.

+ Mileage Reimbursement!

+ Respectful and Desirable Health Aide / CNA Work Setting!

Predictable Hours!
Safe and highly vaccinated work environment including the member population you care for
Our Health Aides and staff love the familiarity and relationships establishes with our members
You will likely find more autonomy and flexibility than you have in your current role
Our model is low-volume and very member and quality care focused

About us:

Summary: Provides personal care, light housekeeping and assistance with ADLs (Activities of Daily Living) as outlined in each SE participant’s plan of care in participant homes as well as at the PACE center; exercises independent judgement; reports any changes in participant status to the IDT; participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines

Responsibilities

Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants’ homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.)
Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team.
Collaborates with members of the Interdisciplinary Team to assure appropriateness and continuity of care.
Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community.
Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants’ motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness.
Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises.
Maintains a clean and safe working and/or living environment in the PACE center and/or participants’ homes.
Assists with meal and snack preparation, serving, feeding as needed, and clean-up.
Uses safe techniques in all interactions with participants at the PACE Center and in participants’ homes.
Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor.
Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions
Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned
Actively participates in regular team meetings for health aides at respective site
Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines
Performs all duties in accordance with FH and Summit ElderCare policies and procedures.

Qualifications

Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate.

License/Certifications:

Certification as a Home Health Aide or Nursing Assistant is desired.

Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

ExperienceOne year of experience working with a frail and/or older adult population, preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently.

Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $21.50 per hour weekdays - $24.00 per hour weekends which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

23:T168d,Overview

About us:

Brief summary of purpose:

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice

Competencies:

Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision.
Specific competencies essential to this position:
- Customer Focus
- Commitment Through Action
- Contributes to Team Performance
- Focus Upon Quality

Responsibilities

Primary Job Responsibilities

Reviews and implements Provider’s orders.
Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and MDS-HC as indicated.
Involves participants and significant other(s) based on needs and abilities.
Delivers care to participants in any setting, including skilled services, based on individualized needs and according to age-appropriate nursing standards.
Provides for cultural and diverse needs of participants when providing care.
Monitors and evaluates therapeutic interventions.
Participates in the development and ongoing review of each participant’s care plan.
Delegates participants’ care responsibilities to other members of the health care team, when appropriate.
Identifies emergency situations and initiates appropriate nursing orders/interventions.
Meets the needs of participants in a timely manner.
Participates in the interdisciplinary team (IDT) process and collaborates with IDT members to meet the needs of participants.
Consistently documents all aspects of participant care, including significant changes in health status, monthly nurses’ notes and health care teaching in the medical record.
Participates in training and orientation of new nursing staff as assigned.
Assists in the delivery of other nursing services as assigned.
Participates in the nursing “on-call” rotation as assigned.
Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures.
Participates in Weekend RN On Call rotation

Qualifications

Education

Graduate of an accredited school of nursing

License/Certifications

License: Current license as an RN in the state of Massachusetts
Certification: CPR and Alzheimer’s certification, or willingness to be certified within 60 days of hire, is essential.

Experience

#P01

24:T1720,Overview

About us:

Brief summary of purpose:

A Business Systems Analyst III will work on projects that generally involve a complex scope. The BSA III is responsible for analyzing and documenting business requirements, documenting business workflow, developing file mapping and technical specifications, and working with business partners/stakeholders to determine priority of requirements. In addition, assesses system capabilities and interdependencies to define and document business solutions. Works collaboratively with the development team, provides complex technical guidance while applying effective design concepts. The BSA III proposes or seeks alternative solutions, when necessary, to ensure the proper balance between business and technical needs.

Responsibilities

Primary Job Responsibilities:

Analyzes and provides high-level project scope for impact and feasibility within the defined time/cost constraints with minimal direction. Assist in the preparation of project scoping documents.
Involved in determining appropriate approach (es) to the business analysis effort and in defining required outcomes/deliverables specific to the project.
Elicits customers/stakeholders’ underlying business needs and concerns through standard methods (i.e., interviews, process workflows for desired state, etc.). Proficient in standard methods and approaches and applies methods and/or approaches as applicable.
Facilitates and documents requirements gathering sessions (involving smaller number of participants) with business representatives/subject matter experts.
Manages through conflicts and competing demands. Escalates to Project Manager, direct manager and other more senior colleagues to help resolve more difficult issues.
Given proficient business acumen, formulates probing questions and shapes effective solutions to difficult problems. Solutions may have implications or impact milestones.
Define and document business requirements clearly and with sufficient detail to enable customer to sign-off and support the completion of the Technical Design Document.
Develops comprehensive use cases to support the solution development, validates use cases with the customer.
Works collaboratively with Development Team to identify data requirements and mapping, establish practical and efficient design and testing approaches, providing suggestions and feedback as appropriate.
Works collaboratively with the Design and Development Team during technical design, programming, and initial testing phases of projects. Collaborate with the business to develop the high-level testing plan based on documented requirements. Creates the comprehensive test plan and queries to be used for testing and documents the test results. Validates the output against the business requirements and identifies defects. Collaborates with the Development Team to understand the level of effort involved for each identified defect. Collaborates with the project team to prioritize and resolve defects.
Create user and training guides. Conduct training and information sessions for user groups as needed.

Qualifications

Education, Licenses, certification and experience requirements:

Education: Bachelor Degree equivalent experience preferred.

License: None

Certification: None

Experience:

Requires 5 to 10 years of business analysis, writing SMART requirements managing scope, elicitation skills, process mapping, communication skills, etc. or equivalent experience
5+ year experience writing technical specifications or equivalent experience.
5+ year experience in data analysis in an information technology operating environment or equivalent experience.
Excellent understanding of and experience working with relayional concepts and business applicability in healthcare management.
Intermediate knowledge of SQL and Relational technology and proficient query writing experience or equivalent experience.
Two years Healthcare Industry experience required

25:T1546,Overview

Start your day from a home office!
2-3 assessments per day!

About us:

Brief summary of purpose:

The Assessment Nurse Case Manager completes face-to-face home visits for new enrollees within 30 days of enrollment to onboard and completes regulatory assessments. The Assessment Nurse Case Manager completes in person Health Risk Assessments (HRAs) in accordance with members assigned frequency. The Assessment Nurse Case Manager completes all new Personal Care Attendant (PCA) Assessments using the integrated time for task tool and well as yearly PCA reevaluations. The Assessment Nurse Case Manager is also responsible for the timely and accurate submission of yearly (and when there is a significant change in status) MDS assessments. Assessments are done primarily in person but may at times be completed telephonically.

Responsibilities

Overview

Conducts home visits for onboarding and regulatory assessments.
Completes HRAs and PCA assessments.
Submits MDS assessments.
Provides education on NaviCare case management program.
Conducts telephonic assessments when appropriate.
Collaborates with Care Team.
Completes LTSS evaluations and collaborates with UM.

Member Assessment, Education & Advocacy

Conducts in-home assessments with motivational and culturally sensitive interviewing.
Performs medication reconciliation.
Completes State-required assessment tools per contract.
Conducts functional assessments for LTSS programs.
Participates in training and audits.
Completes telephonic/virtual assessments.
Maintains program/policy knowledge to educate members.
Supports HEDIS, Medicare 5 Star, and other initiatives.

Qualifications

Education:

Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred.

License:

Active, unrestricted license as a Registered Nurse in Massachusetts

Certification:

Certification in Case Management strongly desired

Other: Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Experience:

1+ years of clinical RN experience with complex medical, behavioral, and social co-morbidities.
Ability to conduct assessments in-person and telehealth.
Ability to work on interdisciplinary teams.
Skill in screening social determinants of health.
Strong communication and interviewing skills.
Problem-solving skills and adaptability.
Knowledge or willingness to learn regulatory requirements.
Preferred experience: Home Health, OASIS/MDS, Medicare/Medicaid, face-to-face member interactions.
Reliable home internet.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $96,000 - $105,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P01

26:T15d0,Overview

About us:

Brief summary of purpose:

Under general supervision of the Clinical Manager and Primary Therapist provides and documents the full range of Physical Therapy assistant treatments and tests to all categories of patients, supervises supportive personnel and participates in educational services. Acts as a clinical instructor and is responsible for teaching inter-department continuing education/in-services.

Responsibilities

Primary job responsibilities:

Under the supervision of Physical Therapist performs processes involved in the delivery of age-appropriate patient care. Provides care appropriate to the patient population served. Completes all required competency assessments.
Identifies, reports and documents the need for modification of treatment techniques. Determines reports and documents possible cause(s) of change in patient’s physical/mental status, tolerance to treatment, unanticipated rate of progress. Determines appropriate modifications.
Identifies, reports and documents acute changes in patient physiological status. Communicates acute changes in patient status to Physical Therapist. Modifies treatment as appropriate within plan of care.
Implements appropriate treatment techniques as specified in therapist plan of care. Implements all treatment procedures as necessary for specific patient population under direction of Physical Therapist.
Able to utilize all appropriate equipment per department protocols and standards.
Communicate effectively with patients and caregivers. Provides and documents specific training related to patient’s dysfunction. Provides patients educational materials appropriate to patient and family needs.
Provides clinical instructions to affiliate physical therapist assistant students. Accepts assigned students for designated clinical affiliation experiences. Actively cooperates with other personnel to achieve clinical education program objectives.
Provides clinical education/instruction of staff. Actively participates in department’s clinical education program serving as an instructor for staff continuing education in-services.
Meets department standards for scheduling and productivity.

Qualifications

Education, Licenses, certification and experience requirements:

Education:

Associates degree from an accredited Physical Therapy Assistant Program.

License/Certifications:

Driving a motor vehicle is an essential job function of this position and the following requirements apply:
- Must possess a valid drivers’ license and have a satisfactory drivers’ record report
- Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
- Must have reliable transportation
- Must meet the requirements of Fallon Health’s Drivers’ Safety Policy
Licensure in Massachusetts or licensure pending via examination or reciprocity.
CPR certification or willingness to be certified within 60 days of hire

Experience:

Minimum of 1 year experience with elderly population.

Pay Range Disclosure:In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 39.00 per hour which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P01

27:T1cce,Overview

About us:

Brief summary of purpose:

The Navigator–Care Management is part of an interdisciplinary care team that coordinates care, improves access, and supports quality outcomes for NaviCare members. The Navigator builds relationships with members/caregivers via phone and in person, conducts home visits as needed, helps implement care plan interventions, and works to remove barriers to care. In partnership with the Nurse Case Manager, the Navigator updates care plans and provides holistic case management for low-, moderate-, and high-risk members.

Responsibilities

Primary Job Responsibilities

Member Education, Advocacy, and Care Coordination

Conduct phone and, as appropriate, in-person assessments, screenings, and visits using TruCare; update individualized care plans and aim for first-contact resolution in a culturally responsive manner.
Coordinate and follow up on care needs, including post-transition outreach, appointment scheduling, medication support, and service monitoring.
Educate members/representatives on benefits, coverage criteria, rights, appeals, authorizations, and evidence of coverage.
Identify and address gaps in care (e.g., PCP assignment, preventive screenings, vaccinations) per established protocols.
Screen for social determinants of health and refer to community resources (e.g., food, housing, fuel assistance, transportation); escalate clinical decisions to the Nurse Case Manager or PCP.
Advocate for members’ access to covered benefits and coordinate with community agencies for non-covered supports.

Provider Partnerships and Collaboration

Participate in—and as appropriate, lead—care plan meetings with providers, partners, and care team members.
Collaborate with the interdisciplinary team (e.g., LTC, behavioral health, advanced practitioners, community partners) to support coordinated care.
Build effective working relationships with community partners and providers (e.g., housing, ADH, assisted living, LTC facilities, PCPs) to support timely, member-specific communication.

Access to Care

Submit and track requests/authorizations for covered services; ensure accuracy and timeliness per program workflows.
Educate members and providers on authorization processes and help resolve authorization issues.
Facilitate access to medical, behavioral health, and social services, including arranging transportation when needed.

Care Team Communication

Communicate timely updates with members, caregivers, providers, and internal teams on care plans, service changes, and member status.
Partner with LTC and community teams during admissions, transitions, and discharges to ensure continuity of care.

Regulatory Requirements, Documentation, and Reporting

Complete required activities to meet CMS/State, NCQA, HEDIS, and other standards (e.g., welcome calls, screenings, care plans).
Document accurately and on time in TruCare and related systems; review and validate member panel data and reports.

Additional Responsibilities

Maintain knowledge of program benefits, policies, procedures, and community resources.
Support operations by covering assignments, adapting to priorities, and completing other duties as assigned.
Mentor or train staff on job-related processes and workflows, as assigned.

Qualifications EducationCollege degree (BA/BS in Health Services or Social Work) preferred License/Certifications

License: N/A

Certification: Community Health Worker - preferred

Other: Satisfactory Criminal Offender Record Information (CORI) results

Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Education

2+ years’ experience in managed care and/or community-based health and human services (e.g., home health, personal care management, independent living, ASAP, or relevant state agencies) preferred
Understanding of hospitalization and post-discharge needs required
Working knowledge of medical terminology, common conditions, and medical record documentation; able to identify triggers requiring RN intervention required
Motivational interviewing experience and ability to work effectively with diverse and non-English-speaking populations required
Understanding of social determinants of health required
Proficiency with Microsoft Office (Excel, Outlook, Word) required
Experience with face-to-face member visits and working with providers/community partners preferred
Experience working on a multidisciplinary care team within a managed care organization preferred

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $28/hr - $30/hr which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

#P02

28:T1cce,Overview

About us:

Brief summary of purpose:

Responsibilities

Primary Job Responsibilities

Member Education, Advocacy, and Care Coordination

Conduct phone and, as appropriate, in-person assessments, screenings, and visits using TruCare; update individualized care plans and aim for first-contact resolution in a culturally responsive manner.
Coordinate and follow up on care needs, including post-transition outreach, appointment scheduling, medication support, and service monitoring.
Educate members/representatives on benefits, coverage criteria, rights, appeals, authorizations, and evidence of coverage.
Identify and address gaps in care (e.g., PCP assignment, preventive screenings, vaccinations) per established protocols.
Screen for social determinants of health and refer to community resources (e.g., food, housing, fuel assistance, transportation); escalate clinical decisions to the Nurse Case Manager or PCP.
Advocate for members’ access to covered benefits and coordinate with community agencies for non-covered supports.

Provider Partnerships and Collaboration

Participate in—and as appropriate, lead—care plan meetings with providers, partners, and care team members.
Collaborate with the interdisciplinary team (e.g., LTC, behavioral health, advanced practitioners, community partners) to support coordinated care.
Build effective working relationships with community partners and providers (e.g., housing, ADH, assisted living, LTC facilities, PCPs) to support timely, member-specific communication.

Access to Care

Submit and track requests/authorizations for covered services; ensure accuracy and timeliness per program workflows.
Educate members and providers on authorization processes and help resolve authorization issues.
Facilitate access to medical, behavioral health, and social services, including arranging transportation when needed.

Care Team Communication

Communicate timely updates with members, caregivers, providers, and internal teams on care plans, service changes, and member status.
Partner with LTC and community teams during admissions, transitions, and discharges to ensure continuity of care.

Regulatory Requirements, Documentation, and Reporting

Complete required activities to meet CMS/State, NCQA, HEDIS, and other standards (e.g., welcome calls, screenings, care plans).
Document accurately and on time in TruCare and related systems; review and validate member panel data and reports.

Additional Responsibilities

Maintain knowledge of program benefits, policies, procedures, and community resources.
Support operations by covering assignments, adapting to priorities, and completing other duties as assigned.
Mentor or train staff on job-related processes and workflows, as assigned.

Qualifications EducationCollege degree (BA/BS in Health Services or Social Work) preferred License/Certifications

License: N/A

Certification: Community Health Worker - preferred

Other: Satisfactory Criminal Offender Record Information (CORI) results

Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Education

2+ years’ experience in managed care and/or community-based health and human services (e.g., home health, personal care management, independent living, ASAP, or relevant state agencies) preferred
Understanding of hospitalization and post-discharge needs required
Working knowledge of medical terminology, common conditions, and medical record documentation; able to identify triggers requiring RN intervention required
Motivational interviewing experience and ability to work effectively with diverse and non-English-speaking populations required
Understanding of social determinants of health required
Proficiency with Microsoft Office (Excel, Outlook, Word) required
Experience with face-to-face member visits and working with providers/community partners preferred
Experience working on a multidisciplinary care team within a managed care organization preferred

Pay Range Disclosure:

#P02

29:T1d71,Overview

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s NaviCare is a program for people age 65 and older, who live in our service area, and who have MassHealth Standard, and may have Medicare. It combines MassHealth (Medicaid) and Medicare benefits, including prescription drug coverage. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region.

Brief summary of purpose:

This position requires that the Account Executive achieves personal referral and outreach goals for the NaviCare program. Manages a territory and group of referral source accounts, providing regular follow up and overcoming barriers with each account to meet enrollment goals.

Responsibilities

Primary Job Responsibilities:

1-Relationship Building

Creates productive and collaborative relationships with internal and external referral sources in order to obtain qualified referrals and enrollments for the NaviCare program.
Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events to ensure Fallon Health’s visibility and presence in your territory.
Presents the NaviCare program to groups who are likely prospects, caregivers and community referral sources.
Develops and implements their own territory business development plan and carries out activities to penetrate accounts listed on the plan.

2-Lead Generation

Works collaboratively with Navicare enrollment team to discuss progress of referrals and ideas for resolving issues.
Provides inservice orientations to vendors and providers on an annual basis.
Shows accountability and follows up with prospects until the lead is closed/withdrawn and document as appropriate. Achieves monthly referral and home visit request goals

3-Secure Applications

Generates sufficient NaviCare enrollment applications to meet monthly enrollment goals.
Explains the NaviCare program clearly and consistently to prospects and their families to ensure that prospects enroll with a solid understanding of the program maintaining a low disenrollment rate. Meets with NaviCare prospects in their homes.
Completes application and other documentation needed.
Submits all completed applications in a timely manner as required by CMS.

4-Tracking & Reporting

Documents all sales activities in the department’s CRM application and account management grid in a timely manner.
Meets weekly sales activity deliverables consistently, and tracks these in the CRM and their Outlook calendar.
Maintains records of NaviCare applications and documentation related to scope of appointments.

5-Assessment

Regularly reviews effectiveness of efforts against goals. Provides market intelligence to the NaviCare/ Manager and the Outreach Director so that adjustments can be made to tactical plans.
Manages their own professional development by seeking advice, training, and coaching from their colleagues, manager, and the Director of Outreach.

6-Regulatory Guidelines

Operates within the marketing and outreach guidelines and regulations provided by CMS and EOHHS.
Retains Scope of Appointment and other Enrollment Records.
Submits information on NaviCare prospect events to Outreach Support in a timely manner, for CMS submission.
When in doubt, asks questions pertaining to compliance or privacy regulations.
Must meet monthly, quarterly and year end enrollment goals.
Must maintain a minimum number of activities and event designed to generate leads for enrollments.
Must keep up to date all records related to leads in CRM system, Account Management Grid and any other report requested by your manager.
Must cause to have at minimum 10 actively referring account.
Must work to develop at least 10 new accounts every month.
Must attend all required Department and collaborating Department meetings.
Must complete and deliver on time reports, documentation, and yearly business plan for your territory.

Qualifications

Education,

BS or BA degree and/or comparable experience

Certification and Licenses:

Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Experience:

Knowledge and experience working with community organizations, low income communities and the elderly
3 years of sales experience in healthcare or group insurance strongly preferred.
Must have proven experience working in a customer facing role focused on sales, lead generation in a high paced customer service or sales environment.
Knowledge of Medicare, Medicaid and insurance products is desirable.
Knowledge of customer service, sales, outreach and marketing principles and practices.
Possession of a valid Mass. driver’s license and a vehicle to be used for marketing activities and home visits.

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is around $65,000 - $71,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

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