About us:

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, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. 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. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose: 

The Community Services Program Coordinator is an individual‑contributor, operational role responsible for the day‑to‑day coordination and execution of assigned Fallon Health’s community‑based programs, including ACO Community Partner programs (Behavioral Health and LTSS), Aging Services Access Points (ASAPs), Geriatric Service and Support Coordinators (GSSCs), and Health‑Related Social Needs (HRSN) services.

This role focuses on accurate processing, tracking, communication, and workflow adherence, serving as a primary operational point of contact for internal teams and external partners. The Coordinator executes established processes, supports program performance through timely data and reporting, and escalates clinical, compliance, or complex issues to Program Management or Care Management leadership as appropriate.

Primary Job Responsibilities (include duties that represent 5% or more of employee's time)

Program Coordination & Execution

• Coordinate and track referrals for Behavioral Health CP, LTSS CP, and HRSN programs, ensuring accurate member assignment and enrollment.
• Maintain accurate program rosters, referral logs, and tracking tools to support operational performance and reporting.
• Support monthly workflows related to LTSS, CP, ASAP, and GSSC coordination.

Partner & Internal Communication

• Serve as an operational point of contact for assigned Community Partners, LTSS vendors, ASAPs, GSSCs, HRSN agencies, and internal care teams.
• Respond to routine partner, vendor, and service‑related inquiries, including PCA and non‑medical transportation questions, in accordance with established guidelines.
• Participate in internal and external meetings and support documentation, follow‑up, and action tracking.

LTSS & Utilization Support

• Support LTSS utilization management and authorization workflows in collaboration with Care Management and UM staff.
• Identify workflow issues, member access barriers, or recurring partner challenges and escalate to Program Management.

Data, Reporting & Compliance Support

• Prepare and maintain operational reports and data extracts for internal teams (SCO or ACO), Community Partners, ASAPs and EOHHS as directed.
• Ensure documentation and tracking meet contractual, regulatory, and turnaround‑time requirements.
• Identify trends, data discrepancies, or training needs and escalate appropriately.

Perform other duties as assigned 

Education: 

•  Associate degree required
•  Bachelor’s degree preferred (Social Work, Human Services, Health Services, or related

Experience: 

• 2–4 years of experience in healthcare, behavioral health, LTSS, or community‑based services
• Experience with Medicaid ACOs, Community Partners, ASAPs, GSSCs, or LTSS vendors preferred

Additional performance requirements: 

• Excellent communication and organizational skills;
• Ability to multi-task and manage competing priorities
• Critical thinking skills for independent problem solving;
• Experience coordinating and collaborating with multiple internal/external stakeholders coordinate and collaborate with CP Partners;
• Capable of merging, synthesizing and validating data from multiple sources;
• Ability to conduct accurate and timely data entry.

 Other:  Satisfactory Criminal Offender Record Information (CORI) results.

             Reliable transportation

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $68,000 - $74,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

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.