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.
Position Overview:
The UM 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 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.
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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 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 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.
-
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 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 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.
-
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 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 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.
-
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.
The ACO Transition of Care Nurse Case Manager (NCM) is focused on care coordination and improving quality of care and access to services for Fallon ACO members at time of care transition – i.e. after hospital, emergency room, skilled nursing facility discharge to home. The NCM will work in collaboration with the ACOs and Community Partners to support the members in a role that may include completing in-home/facility face to face visits with members and/or providers. Responsibilities include: telephonically assessing a Member’s clinical/functional status to identify ongoing special conditions and providing education. Develops and implements a coordinated plan in collaboration with the member, ACO, Community Partners and Primary Care Provider and/or specialist and other community partners to ensure quality outcomes in a cost effective way. Facilitates referrals to Clinical Integration RN team for further member follow-up and/or follow-up with the Care Teams at the ACO and/or Community Partners. Works collaboratively with other members of the Clinical Integration Team.
** This role is based in Worcester MA**
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Fallon Health Weinbergis 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.
Fallon Health Weinberg in Amherst, NY is currently seeking an experienced RN Nurse Care Manager for our quickly expanding MLTC program. This is a full time day, Monday - Friday, RN nursing position. At Fallon Health Weinberg, you’ll find a competitive salary, comprehensive benefits and a stimulating, collaborative culture. Our dedicated professionals truly work as a TEAM, united by compassion for the people we support, each contributing to our innovative approach to health care.
Fallon Health Weinberg is increasing access to high-quality, person-centered, cost-effective health care programs for older individuals who require supportive services due to long-term health needs but want to remain living independently in the Buffalo NY community.
We currently offer three plans to provide care and care coordination for people in their homes:
- Managed Long Term Care Plan (MLTC)
- PACE: Program of All Inclusive Care for the Elderly.
Under the direction of the Director of Clinical Services (DCS), the FHW Care Manager (CM) is able to work both independently and collaboratively with other members of the FHW Program Primary Care Team. The CM follows established departmental policies and standards for timely completion of assigned work. Problems lacking clear precedent are reviewed with DCS or her/his designee prior to taking action. The CM presents a clear definition of problem(s) when reviewing with the Primary Care Team, Primary Care Physician and/or Medical Director.
The FHW Care Manager (CM) assesses a Members clinical/functional status and develops a plan to coordinate a continuum of care consistent with the Members health care needs and/or goals. The Individualized Care Plan (ICP) supports the Member attaining and/or maintaining an optimal functional status. The CM is an active participant in the Members Interdisciplinary Care Team (ICT) and is an advocate for the Member.
The CM is actively involved with the Member at times of care transition, including but not limited to planned and unplanned admissions, and works in conjunction with the members team to ensure care plan communication between all providers and members of the ICT.
The CM coordinates care between multiple medical and Primary Care Team Providers. The CM is able to identify services, care delivery settings, and recommends alternatives where appropriate.
The CM monitors the care and provides consistent feedback to team on progress. The CM collaborates and works with all members of the Interdisciplinary Care Team and, when appropriate, the FHW care manager will work with Acute care hospitals, rehab facilities and skilled nursing facilities to ensure an effective care plan to meet member care needs. The CM may attend Facility Discharge Planning Rounds and works to ensure a smooth discharge and transition as appropriate
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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 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 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.
-
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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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:
With supervision from the Senior Manager of Quality Services, the Nurse Reviewer – HEDIS is accountable for the review of clinical quality data for the purpose of HEDIS® reporting. Projects include medical record data abstraction from multiple sources. The nurse provides clinical expertise, technical support and data analysis for HEDIS measures.
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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.
Summary:
We are Searching for a Strong Clinical Leader with a good business acumen to oversee one of our PACE Centers (Program of All-inclusive Care for the Elderly). Fallon Health’s Summit ElderCare Program is a Community-Based integrated care model with a mission to support seniors in the community as an alternative to nursing home care. Our focus is on caring for older adults in an environment that helps to optimize their quality of life and independence by helping them to stay in their homes and communities.
The ideal candidate must have supervisory experience working in an Integrated & Value-based care model, a Strong Clinical background, solid Business Acumen, with Proven Leadership in the areas of communication, conflict management, and personnel management.
Bachelor’s Degree in a related field is Required. Master’s Degree preferred.