Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenOverview
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, 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. Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home.
At Fallon Health, 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— in the region.
Brief summary of purpose Provides coordination, scheduling and problem resolution for all approved home care services for SE participants. Documents all actions in a timely manner in an electronic medical record (EMR). Supports other program administration needs as assigned.
Responsibilities
Primary Job Responsibilities Coordinates and schedules home care services to implement the plan of care established by the interdisciplinary team (IDT). Works collaboratively with Home Care nurses and other staff, vendors, participants and families to support SE’s mission, promote high quality care and service as well as positive internal and external customer relations. Communicates with homecare agencies and other vendors to coordinate services including initial orders, changes, cancellations and resumption of services. Demonstrates professionalism and acts as an ambassador for Fallon Health and Summit ElderCare at all times Emails or faxes open case needs to homecare agencies as required.
Effectively utilizes established systems and procedures to identify problem cases and alert management of need for additional interventions. Follows up on all non-assigned cases as required until services are secured. Documents all vendor authorizations and service coordination efforts in the EMR and other identified systems as assigned. Documents all participant related telephone calls in the EMR. Faciliates timely delivery of service authorizations to vendors. Maintains a positive working relationship with peers, vendors and other staff. Maintains an accurate record of participants’ home care services in a designated format. Utilizes established systems to track data as assigned.
Prepares reports as requested. Conducts periodic audits of claims paid to ensure services were authorized by the IDT and facilitates resolution…
About Fallon Community Health Plan
From its Form 990- Budget $1.84B · Health Care
- Staff 1,346 · founded 1975
- Pays its leaders $325K–$675K (12 reported)
- Open jobs 47 · Jobs at Fallon Community Health Plan · Full 990 report