About us:

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)  to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara.

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. 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.

At Fallon Health Weinberg, 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. 

Brief summary of purpose: 

Assists the FHW PACE Program Director to oversee and manage PACE program level operational and regulatory functions in support of the program’s quality, strategic and financial goals. Responsible for compiling reports and analyzing data and making program level recommendations. Responsible for supporting PACE site related to the development and implementation of processes and workflows, network development, contract management, claims, billing, and authorization assistance. This position may require intermittent travel to local contracted partners to provide support/guidance on various operational topics.

$95,000

Primary Job Responsibilities:

Data management, analysis, and reporting:

• Oversees state and regulatory reporting deliverables for PACE
• Oversee the collection and compilation of PACE data, prepares reports and organizes materials in preparation for assigned meetings.
• Conduct analysis of identified business operational issues as they arise; evaluate and make recommendations to PACE leadership team for resolution.  

Clinical processes:

• Working with the Clinical Leadership team to develop, implement, monitor, audit and report on effectiveness of clinical and operational processes and their effectiveness on managing the Medical Loss Ratio as per organization’s goal.

Regulatory oversight and compliance:

• Develop policies/procedures and workflows for key operations and manage the communication/implementation.
• Monitor federal and state regulations pertinent to the PACE programs, communicate pertinent updates and changes to the PACE leadership team and lead the implementation of process/program changes as needed.
• Manage the  implementation of regulatory changes as assigned including communication, education/training and oversight.
• Organize and prepare the PACE sites for any internal or external site reviews or audits including those conducted by CMS and/or the State, FH Internal Audit, Medicare Programs.
• Participate in assigned workgroups, list serves and committees to monitor regulatory and industry trends
• Provide periodic updates to the PACE leadership team.

Training, Marketing, and Research:

• Provide mentoring, training, and leadership to other PACE Operations staff as required.
• Conduct independent research including primary and secondary research. Analyze options and make recommendations as it relates to PACE business operations practice.
• Support marketing plans for PACE to grow membership and reinforce brand awareness in service areas.
• Provides education and instruction to PACE site staff as needed to ensure established operational processes and workflows are adhered to
• Acts as a resource to PACE sites related to PACE operations processes and workflows
• Project management and special projects:
• Serve as lead on key PACE projects and initiatives as assigned.
• Independently manages assigned projects from design, project plan implementation, education, post project monitoring and transition to standard operational processes.

PACE Member Satisfaction:

• Reviews monthly SE satisfaction surveys
• Attends the monthly FH Service Advisory Committee meeting as PACE representative and reports on satisfaction survey scores below 9 as well as other Service Quality related topics
• Attends Service Quality Meeting quarterly and works with leadership and PACE sites to plan interventions and improvement activities for increasing Participant satisfaction scores, reports back to FH Service Advisory Committee

Other Operations Responsibilities

• Acts as a resource to and supports PACE Senior Leadership Team in various program-wide projects and initiatives as needed and assigned
• Works with Application Support Specialists and others in FH’s ancillary departments (IT, Medical Economics, etc.) to build reports and collect data as necessary from the EMR and QNXT
• Assists in preparing FHW PACE Program for all site reviews or audits conducted by CMS, the State or other external regulatory entities
• Provides periodic updates to the PACE leadership team.
• Attends program-level, organizational-level and external meetings and committees representing PACE operations as assigned and reports key updates to FHW PACE Program Director
• Serves as a lead on key PACE projects as identified. Responsible for timely and complete execution on all assigned projects from project plan development to implementation.
• Compiles data for PACE monthly regulatory monitoring program and dashboard

Qualifications requirements

Education: 

Bachelor’s degree in health care administration, business administration or related field preferred

License/Certifications: 

N/A

Experience: 

• A minimum of 5 years’ experience in health care, elder services, business administration or related field   
• A minimum of 2 years of regulatory compliance experience required
• Understanding of Medicare and Medicaid regulations a plus
• Excellent written and verbal communication skills
• Ability to establish effective productive relationships with peers and leaders
• Ability to work independently and exercise sound judgment 
• Ability to establish effective record-keeping systems and prepare clear and concise reports
• Comfortable delivering constructive feedback to peers and indirect reports on performance and productivity
• Comfortable interacting with individuals at all levels of FH.
• Comfortable interacting with and onboarding newly contracted external partners

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.