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 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.

Brief summary of purpose:

Works closely with SE Site Director to provide day to day oversight of PACE operations for assigned PACE site of 400 or more participants. Responsible for coordination and supervision of all clinical staff, financial, and business aspects of a PACE team of 200 participants or more. Manages all administrative functions related to running a PACE center. Responsible for hiring, training, supervision and retention of support/administrative staff, Supervisor of Recreational Activities and Registered Dietitians. Responsible for oversight of all PACE center staff in the absence of the Site Director. Oversees the timely and accurate processing of claims, data collection and reporting including those related to the Electronic Medical Record (EHR). Assures that all functions are completed in an accurate and timely manner. Maintains a positive, professional, collaborative relationship with staff and vendors. Ensures all Level one and two incidents and grievance investigations and reports are filed in a timely manner in accordance with PACE regulations and SE policies and procedures. Oversees Acts as PACE site Transportation Coordinator and oversees the provision of transportation services for all site participants. Responsible for all site facilities management, working closely with Director of Facilities to ensure all systems are working properly and all equipment is maintained according to the prescribed schedule. Acts as SE liaison to site vendors. Works closely with Outreach & Enrollment staff to ensure the intake process flows smoothly, to ensure prospects are scheduled in a timely manner and the team is prepared for swift enrollment decisions. Acts as back up to Site Director in his/her absence. Oversees the site Activity program working closely with the Supervisor of Recreational Activities to ensure age-appropriate, interesting and varied activities are available for participants on a daily basis Oversees the Registered Dietitians to ensure timely regulatory assessments.

Responsibilities

Detailed List of Ongoing Responsibilities as Needed:

• Provides oversight of day-to-day PACE center operations in collaboration with SE Site Director acting as primary back up in his/her absence

• In collaboration with SE Site Director, analyzes and manages utilization metrics and targets to ensure favorable financial outcomes

• Oversees Manages Incident and Grievance reporting for the PACE site ensuring all reports are filed and completed in the established timeframe

• Oversees Responsible for all Level one and two investigations and reports working closely with assigned Quality RN

• Manages all supervisory functions for site based Registered Dietitians, support staff and Supervisor of Recreational Activities including hiring, training and performance management. Completes annual employee evaluations and competencies. Conducts monthly staff meetings. Conducts regular touchpoint meetings with all direct reports to provide guidance and feedback on progress toward established goals    

• Oversees intake and enrollment process for prospective enrollees, working closely with Outreach and Enrollment staff    

• Assures that all demographic and other non-clinical information is entered into the EHR and documents are scanned according to established procedures.   

• Acts as Site Transportation Coordinator to assure safe and timely transport of all participants to/from the site, home and appointments. Meets regularly with transportation vendor to work through any issues and foster good rapport 

• Meets regularly with vendors to ensure open communication and collaboration in service provision for participants   

• Collects and enters all data related to HPMS reporting for PACE site.  

• Oversees the timely processing of all claims and invoices and referrals, ensuring all external appointments are scheduled timely.     

• Receives and processes all memorial donations ensuring letters of appreciation are sent in a timely manner      

• Oversees Maintains attendance logs and meeting minutes and certification logs as requested by Site Director.

• Assures that front-desk/reception area is staffed at all times while site is open.

• Manages and maintains appointment scheduling functions including assisting participants with scheduling outside appointments.

• Responsible for attending and taking minutes for various meetings as assigned by the Site Director.

• Works with Director of Facilities to ensure all equipment and systems are maintained and in good working order; reports issues immediately

• Acts as facilitator of SE Office Supervisor committee meeting regularly and providing guidance and leadership to work through issues affecting all sites

• Other duties and special projects as assigned by the Site Director

• In Collaboration with the Site Director, provide feedback on annual budget and ongoing monitoring of expenses.

• Oversee the site-specific safety and emergency evacuation plan in the absence of the Site Director

• In the absence of the Site Director collaborate with the SE Director of Facilities Management; oversee maintenance of the facility to meet necessary certification and quality standards.

• Facilitate daily interdisciplinary team meetings

• Ensure close coordination between participant, family, program staff, primary medical providers and external providers in carrying out individual care plans.

• Foster relationships with Assisted Living Facilities, which would include at minimum monthly meetings.

Qualifications

Education

• Bachelor’s Degree in healthcare related field in Nursing or other clinical discipline required.

License/Certifications

• If Registered Nurse, Physical Therapist, Occupational Therapist, valid license in State of Ma is preferred.

Experience

• At least 3 years supervisory experience in a clinical care setting

• Strong experience in a health care or insurance setting preferred but not required.

• PACE experience or experience in an integrated value-based clinical care model preferred

• Excellent Strong computer skills including using an Electronic Medical Record. including familiarity with information retrieval, data collection and word-processing

Resources

QNXT, Microsoft Office Suite, Nextgen, Incident/Grievance system; Must have access to reliable transportation to perform the essential functions of this role

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

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.

#P02

Location US-MA-Springfield

Posted Date 1 day ago (10/29/2024 12:47 PM)

Job ID 7757

# Positions 1

Category Medical Management