Here are our current job openings. Please view the details for more information, and apply from that page if you are interested.
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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 of Purpose:The Navigator II is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. The Navigator II partners with Fallon Health Care Team staff and other providers to communicate at all times what is occurring with the member and their status. The Navigator II seeks to establish face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan. Responsibilities include: conducting face to face/telephonic health risk assessments and identifying Fallon Health Care Management Programs the member may benefit from; educating members about their benefits; helping to ensure that physician office visits are scheduled and attended; placing referrals and following up to ensure services are in place as per the individual care plan and developing care plan in conjunction with the Care Team and sending care plans to providers. The Navigator II refers to the Nurse Case Manager/PCP whenever clinical decision making is required. In order to effectively advocate for member needs, the Navigator II may make in home or facility visits with or without other Care Team members to fully understand a member’s care needs.
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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 of Purpose:The Internal Navigator serves on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. The Internal Navigator supports the Clinical Integration Team in a role that does not routinely complete in home visits. Responsibilities include: phone coverage/triage calls to appropriate team, completing telephonic health risk assessments, uploading documents into TruCare (care management platform), assist the team with identifying gaps in care and follow-up per program protocol (e.g. Key Metrics, Influenza, etc.), assisting the member in scheduling appointments, as appropriate, assisting the team with obtaining medical records and other required documents from the health care providers and ensuring uploading into TruCare, and assisting with letter generation and mailings.
The Internal Navigator serves on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon ACO members.
Responsibilities include but are not limited to:
- Performs care coordination for members adhering to contact and duration frequencies documenting all activities in the TruCare system utilizing the appropriate assessment and/or note type following Clinical Integration Documentation Policy
- Conducts the product specific screenings and assessments with members over the telephone, entering such into the system, and referring members for interventions based upon established criteria based upon member responses
- Receives completed assessments/screenings for various products from the Fallon Health Customer Service Unit and also in the mail from members, enters such into the system, and refers members for interventions based upon established criteria based upon member responses
- Provides phone coverage/triage calls from members and/or provider and community partners looking for care coordination assistance, benefit education, and connections to Fallon Health Clinical Integration Team members
- Uploads documents into the TruCare system, creating tasks for RNs to review documents
- Manages incoming Queues for products as assigned, routing and sending incoming TruCare tasks to the appropriate Team member
- Contacts members to resolve gaps in care including but not limited to: PCP assignment, PCP visits, preventative screenings, vaccination reminders, and other initiatives as assigned
- Educates members/PRAs about their product specific benefits and how to access often times facilitating and coordinating such
- Helps members to ensure physician office visits are scheduled and attended
- Places referrals and following up to ensure services are in place as per the individual care plan and developing care plan in conjunction with the Care Team, preparing and sending member specific care plans per process
- Performs care coordination for members adhering to contact and duration frequencies documenting all activities in the TruCare system utilizing the appropriate assessment and/or note type following Clinical Integration Documentation Policy
- If working on the ACO or Commercial Products: Contacts maternity members after hospital discharge to facilitate delivery of items as part of the ‘Oh Baby’ program and works with Nurse Case Managers to coordinate after care needs
- Helps members obtain access to care including but not limited to working with providers to arrange medical and behavioral health appointments and following up with members afterwards to ensure they attended, if not determine barriers, and work to have members attend appointments as required
- If working on the ACO Member Population: Facilitates transportation to medical and behavioral health appointments by completing the MassHealth PT-1 process on behalf of the member/provider
- If working on the NaviCare Member Population: Facilitates transportation to medical, behavioral health, and social appointments by educting the member about the process to request transportation and/or working to assist the member to obtain such
- Educates members and assists members to obtain community benefits including but not limited to food through the EBT system, fuel assistance and other community programs and services such as WIC
- Screens members for social determinants and service needs and refers members to Clinical Team members and ACO Partners for intervention based upon criteria and processesThe Internal Navigator refers to the Nurse Case Manager/PCP whenever clinical decision making is required.The Internal Navigator supports the Clinical Integration Team in a role that does not routinely complete in member and/or provider face-to-face visits.
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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 fallonhealth.org.
About NaviCare:
Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes.
Brief Summary of Purpose:
The Nurse Case Manager (NCM) Internal is focused on care coordination and improving quality of care and access to services for Fallon members. The NCM Internal supports the Clinical Integration Team in a role that does not routinely complete in-home/facility face-to-face visits with members and/or providers. Responsibilities include telephonically assessing a Members clinical/functional status to identify ongoing special conditions and providing education. Develops and implements an individualized, coordinated care plan in collaboration with the member and Primary Care Provider and/or specialist and other community partners to ensure quality outcomes in a cost effective way. Communicates with member/family/caregiver(s) in accordance with frequency of Case Management contact guidelines. Works collaboratively with other members of the Clinical Integration Team to provide overall case management, care plan oversight, and care coordination for our members. After training period ends this role is 3 days remote.
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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 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.
Position Overview:
The clinical assistant performs clinical and administrative duties under the direction of the Clinical Nurse Manager, assists the MD/DO, NP and/or RN in administering care and treatment to participants including but not limited to phlebotomy and EKG in an expeditious, courteous and professional manner, facilitating a smooth flow of healthcare practices, providing basic and direct care to participants as directed, and ensuring a good patient care experience in the PACE clinic.
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WHAT IS A “PACE” PROGRAM?
Programs of All-Inclusive Care for the Elderly (PACE)
The PACE Model of Care is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. These are individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment, and live in a PACE service area.
THE OPPORTUNITY:
Fallon Health’s Summit ElderCare operates 6 PACE programs around Massachusetts and our growth finds us very excited to bring a new physician leader on to the team. This role is considered the second in command and part of the future and growth of Summit ElderCare and you will enjoy being partnered very closely with our PACE Medical Director. You will be intimately involved in every facet of our Summit ElderCare business including (but not limited to); Manage and develop staff, Utilization and Quality Management and regulatory Compliance, Participant care.
ABOUT SUMMIT ELDERCARE:
Summit ElderCare, offered by Fallon Health, is the only program of its kind in Central Massachusetts and is one of eight PACE programs in the State. Currently there are 130 PACE Organizations nationwide across 31 states operating 263 PACE centers. Summit ElderCare provides a combination of medical, social and insurance services using an interdisciplinary team approach to help older adults avoid nursing home placement. The program offers outpatient medical care, social day programming, home care and comprehensive insurance coverage with no co-payments or paperwork for participants. Our physicians and nurse practitioners are able to provide care for the frail elder not available in any other setting. Our comprehensive program is not constrained by the usual insurance company rules and benefit limitations and we have the capacity to offer services that are not often covered by other plans.
The physicians and nurse practitioners have flexibility to devote as much time as needed for the clinical and social needs of our participants and their caregivers to provide individualized quality care by a team of geriatric care professionals who work together with participants and caregivers to address each individual's specific needs. This team of professionals is an essential component of the Summit ElderCare PACE program.
The team uses a collaborative approach to care planning and is called the Interdisciplinary Team (IDT). The IDT is comprised of Providers (MD/DO and NP), Nurses, Social Workers, Physical and Occupational Therapists, Dieticians, Health Aides, Recreation staff, Home Care and Transportation Coordinators and Site Administrator. This approach to care is the gold standard for complex and frail older adults who wish to avoid nursing home placement.
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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 fallonhealth.org.
Brief summary of purpose:
Summary: This position will contribute to an important strategic initiative of Fallon Health in improving the quality of care of our members. With supervision from the Senior Manager Accreditation, the quality Improvement nurse will be responsible for carrying out the assigned quality improvement initiatives such as the development and implementation of member outreach strategies, and the acquiring of clinical quality data analysis, and presentation to internal and external customers. Other responsibilities include medical record data abstraction and the development of clinical quality initiatives. The nurse will provide clinical expertise and support for departmental initiatives and the Quality Services program structure.
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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 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.
Position Summary: Per Diem position
Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice.
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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.
Position Overview:
The UM/UR Nurse uses a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify plans of care and/or service requests, focusing on selected complex medical and psychosocial needs of FH members and their families. The UM/UR Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Fallon Health benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination.