Fallon Health

Returning Candidate?

Summit ElderCare Program Manager

Summit ElderCare Program Manager

Job ID 
5046
# Positions 
1
Location 
US-MA-Worcester
Posted Date 
1/8/2018
Category 
Business Development

More information about this job

Overview

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 www.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:

Serves as the program liaison for departments across the organization providing direct and indirect program support including, Network Development and Management (contracting and provider relations), Accounting, Medical Economics, Communications, and other related ancillary departments in Fallon Health. The Program Manager produces related reports both routine and ad hoc to support program operations and continuous improvement.

The Program Manager leads critical program-level strategically important initiatives such as those related to program expansion and CMS audit preparations, for example, and assists the Executive Director in overseeing and managing Summit ElderCare operational and regulatory functions in support of the Leadership teams. This role serves as a member of the Summit ElderCare Leadership Team, the Summit ElderCare Quality and Utilization Management Team, and other committees and workgroups as assigned.

.

Responsibilities

  • In collaboration with FH Compliance department, monitors federal and state regulations pertinent to the PACE program, communicates them to the Fallon Health teams and leads the implementation of process/program changes as needed.
  • Manages the implementation of regulatory changes as assigned including communication, education/training and oversight.
  • Responsible for organizing and preparing the organization for all site reviews or audits conducted by CMS, the State or other regulatory entities
  • Prepares and manages regulatory submissions and associated follow up related to applications, waivers and other information requests.
  • Develops policies/procedures and workflows for key operations and manages the communication/implementation.
  • Participates in assigned workgroups, list serves and committees to monitor regulatory and industry trends
  • Provides periodic updates to the Summit ElderCare leadership team.
  • In collaboration with FH Compliance department, monitors federal and state regulations pertinent to the PACE program, communicates them to the Fallon Health teams and leads the implementation of process/program changes as needed.
  • Manages the implementation of regulatory changes as assigned including communication, education/training and oversight.
  • Responsible for organizing and preparing the organization for all site reviews or audits conducted by CMS, the State or other regulatory entities
  • Prepares and manages regulatory submissions and associated follow up related to applications, waivers and other information requests.
  • Develops policies/procedures and workflows for key operations and manages the communication/implementation.
  • Participates in assigned workgroups, list serves and committees to monitor regulatory and industry trends
  • Provides periodic updates to the Summit ElderCare leadership team.
  • Works closely with Fallon Health’s NDM department regarding network contracting initiatives.
  • Serve as lead on key Summit ElderCare projects as identified.
  • Independently manages assigned projects from design, project plan implementation, education, post project monitoring and transition to standard operational processes.
  • Leads Fallon Health’s work with State and Federal advocacy organizations in support of fully integrated dual special needs plans, including working with America’s Health Insurance Plans (AHIP), the Massachusetts Association of Health Plans (MAHP), National PACE Association and the Massachusetts PACE Organization.
  • Completes applications/waivers for PACE program transitions and expansion including State and CMS notification, contingency planning and working with FH Purchasing department to write RFPs for needed services, etc.
  • Oversee the collection and compilation of SE program utilization data, in collaboration with Medical Economics, prepares multiple Dashboard reports and organizes Quality and Utilization Management Committee materials.
  • Prepares monthly management reports including Membership as well as site and program level financial projections. 
  • Oversees state and regulatory reporting deliverables for PACE
  • Works in collaboration with the SE Senior Director of Operations to prepare, analyze and submit DataPACE submissions to the National PACE Association. Act as primary DataPACE liaison with the NPA, resolves identified issues, and prepares reports for SE leadership as needed.
  • Assist with the annual budget process and ongoing financial improvement activities.
  • Conducts analysis of identified business issues as they arise; evaluates and makes recommendations.  
  • Provides mentoring, training, and leadership to SE Operations Managers as required.
  • Conducts independent research including primary and secondary research. Analyzes options and makes recommendations
  • Supports marketing plans for PACE to grow membership and reinforce brand awareness in service areas.
  • Refines product training modules and educational opportunities.

Qualifications

Education: Bachelor’s degree in health care administration, business administration or related field; Master’s degree preferred.   

 

Experience:  A minimum of 5 years of experience in health care, elder services, business administration or related field. Knowledge of regulatory requirements for health insurance industry, excellent written and oral communication skills, excellent organizational and analytical skills, strong problem-solving skills and conflict resolution skills. Knowledge of PACE regulatory requirements a plus

NOT READY TO APPLY?