Fallon Health

  • Program Coordinator - Growing Health Insurance and a great team!!!!

    Location US-MA-Worcester
    Posted Date 2 months ago(3/6/2018 2:45 PM)
    Job ID
    5139
    # Positions
    1
    Category
    Social Work
  • 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.

     

     

    Summary:

    Under the direction of the Behavioral Health Director ensure timely completion of assigned work in compliance with established departmental policies and procedures. Able to demonstrate independent action. The ACO CP Program Coordinator presents a clear definition of problem(s) when reviewing with the Manager.

    The ACO CP Program Coordinator serves as the single point of contact for the BH CP and LTSS CP. Responsibilities include:

    • Collaborate with ACO and ACO partner regarding members involved with BH and LTSS CP
    • Engage with CP regarding referrals for BH and LTSS CP
    • Assist in implementation of functions between ACO and CP
    • Provide performance management to BH and LTSS CP related to documented processes.
    • Triage urgent calls.
    •  The ACO CP Program Coordinator works closely with the Fallon and ACO Care Managers. The ACO CP Program Coordinator refers to the Fallon and ACO Care Managers whenever clinical decision making is required.

    Responsibilities

     

    • Direct communication with community partners, ACOs and EOHHS.
    • Process referrals and assist in assigning members to the appropriate BH and LTSS CP
    • Responds to questions or concerns about members referred to BH and LTSS CP
    • Engage in discussions with Fallon and ACO Care Managers about members assigned, engaged, or lost to care;
    • Develop rosters for BH and LTSS CP
    • Develop reports for BH and LTSS CP about assigned members and status of these members
    • Facilitates performance management with ACO and MCO ensuring BH and LTSS CP are meeting all requirements of documented processes
    • Attend MassHealth meetings
    • Attend BH and LTSS CP meetings
    • Assists in preparation and review of reports for MassHealth

     

    Additional performance requirements:

    • Excellent communication and organizational skills;

    • Ability to multi-task;

    • Ability to coordinate and collaborate with CP;

    • Accurate and timely data entry; and

    • Computer literacy required.

    Performs other responsibilities as assigned by the Supervisor/designee.

    Qualifications

     

    Education

    • College degree (BA/BS in Social Work, Human Services or Health Services preferred)
    • 2-4 years job experience in a health-care related field or in a behavioral health setting. Experience working with behavioral health providers and LTSS providers.

     

    License/Certifications

    • Current MA Driver’s License

     

    Other: Satisfactory Criminal Offender Record Information (CORI) results

     

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

     

    Usual office environment with frequent sitting, walking, standing, and occasional climbing, stooping, kneeling, crawling and balancing. Frequent use of eye, hand and finger coordination enabling the use of office machinery. Oral and auditory capacity enabling interpersonal communication as well as communication through automated devices such as the telephone.

    Occasional: activity exists less than 1/3 of the time

    Frequent: activity exists 1/3 and 2/3 of the time.

     

     

    Ability to transport self to/from meetings with Enrollees and/or vendor agencies in/around the program services area.

     

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