Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high-quality, affordable health care.
Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all they serve. It consistently ranks as one of the nation's highest-rated health plans, according to the National Committee for Quality Assurance (NCQA).* Fallon Health coordinates care with its Senior Care Options/Special Needs Plan for dual-eligible people who are 65 and older. Fallon Health has operated a PACE program in Massachusetts for more than 20 years and is the largest PACE program in New England and sixth largest nationally.**
Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus. The two parent companies, Fallon Health and Weinberg Campus, have demonstrated consistent commitment to providing an array of solutions that make high-quality, integrated and affordable care more accessible to the poor, disabled and senior populations within the communities they serve.
Director of FHW Clinical Service is accountable for the clinical direction and management of the services of Fallon Health Weinberg MLTC within the FHW service area, including the development, implementation, maintenance and monitoring of all clinical programs and operations as required in the Model of Care contracts between.
FHW and the Centers for Medicare and Medicaid Services (CMS). The Director works closely with members of the FHW leadership team and the Program Director in developing and administering the clinical program to ensure compliance with all relevant aspects of the CMS and NY State Medicaid managed long term care Program.
Oversees integrated clinical assessment, care plan development and implementation, care coordination, case management, health, and wellness activities, health outcomes improvement, medical policy development, utilization management, grievances and appeals.
Leads the development and implementation of quality improvement and care management programs, outcomes measurement and analysis and accreditation activities.
BSN or Master’s degree in Public Policy, Health Policy, Health Administration, Business Administration or Science highly preferred.
current driver’s license
Experience in managed care, health care, health policy and/or health law a plus
experience in consulting to, managing or leading government programs beneficial
Previous experience with NY Medicaid programs, , CMS, IPA’s, ACO’s and Medicare Advantage programs beneficial
Previous management experience required
Experience with care management required
Previous experience with Home/community based service beneficial