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.
Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.
The Navigator helps the primary care provider, nurse case manager, geriatric support services coordinator, long-term care facility liaison and other providers know at all times what is occurring with the Enrollee and their status. Responsibilities include: placing referrals and following up to ensure services are in place as per the individual care plan; coordinating and documenting PCT meetings, facilitating data transfers and ensuring the Centralized Enrollee Record (CER) and Fallon Health Core System is up to date. The Navigator works closely with the Nurse Case Manager. The Navigator refers to the Nurse Case Manager/PCP whenever clinical decision making is required. In order to effectively advocate for Enrollee needs, the Navigator makes in home visits/long term care facility visits with/without the Nurse Case Manager/GSSC to fully understand an Enrollee care needs.
The Navigator seeks to establish a relationship with the Enrollee/caregiver(s)/facilities to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.
College degree (BA/BS in Health Services or Social Work) preferred
Current MA Driver's License
1-3 years job experience in a medical related field or with a healthcare payor company.
Experience in a healthcare payor company a plus.
Experience caring for the geriatric population.
Multi-Lingual desired-Spanish, Vietnamese, Portuguese, Khmer (listed in order of preference)