Fallon Health jobs

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 Behavioral Health Vendor Relations Manager serves as the primary liaison between Fallon Health and its contracted behavioral health vendor. This role ensures seamless contract execution, operational excellence, and financial oversight across all lines of business. The Manager drives strategic partnerships, leads cross-functional initiatives, and promotes behavioral health integration to improve member outcomes and vendor performance. Responsibilities Vendor Management Lead weekly vendor account meetings to address operational needs and resolve issues. Manage behavioral health provider contracts and maintain accurate documentation. Develop and maintain vendor scorecards and performance metrics. Identify and implement process improvements for vendor management. Escalate and troubleshoot vendor-related issues promptly Delegation Oversight & Reporting Manage and oversee the reporting package provided by the behavioral health vendor, ensuring timely and accurate submission of all required reports. Monitor and verify that the vendor consistently meets all compliance, regulatory, and contractual obligations as outlined in agreements. Collaborate with the vendor and organizational leadership to proactively identify areas of concern or non-compliance, and address these through structured discussions during weekly account meetings. Lead weekly vendor account meetings to address operational needs, resolve issues, and review reporting outcomes. Develop and maintain vendor scorecards and performance metrics, using data from reporting packages to drive accountability and performance improvements. Identify and implement process improvements for vendor management, with a focus on compliance and reporting accuracy. Escalate and troubleshoot vendor-related issues promptly, ensuring transparency and alignment with organizational standards. Cross-Functional Collaboration Serve as department lead on cross-functional teams and subcommittees. Coordinate with internal departments (Care Services, Claims, Credentialing, IT, Finance).Promote behavioral health integration across Fallon Health and partner organizations. Communicate vendor updates and coordinate solutions across teams. Provider Relations Management Troubleshoot financial issues related to vendor and provider contracts. Collaborate with vendors to strengthen strategic partnerships with behavioral health providers. Qualifications Education: Bachelor's degree required. Master's degree in Healthcare Administration, MBA, MPP, MPH or similar preferred, but not required. License: License or Certification in behavioral health (e.g., CADC), or as a behavioral health professional (e.g., LMHC, LCSW, LICSW, LADC etc.) is required. Valid Massachusetts Driver's License. Experience: Minimum 3 years in a managerial role overseeing programs, vendors, or operations, preferably in managed healthcare or public sector programs. Knowledge of Medicare and Medicaid reimbursement, behavioral health coding and billing, and state contracts. Familiarity with the continuum of care for SUD and BH services in Massachusetts. Experience with behavioral health integration, alternative payment models, and innovative care delivery strategies. Strong analytical, strategic thinking, and problem-solving skills. Excellent communication skills (verbal, written, electronic). Proficiency in Microsoft Word, Excel, PowerPoint, Project, Planner, and other MS Office tools. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $100,000 - $115,000 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. #P02 Not Ready to Apply? Join our Talent Community now!

Home Infusion Registered Nurse - Accredo Patient visits for this position will mostly be on the weekends, and possibly some evenings. However, some weekday availability will be required, especially during training. Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo by Evernorth has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: * Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. * Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. * Provide follow-up care and manage responses to ensure their well-being. * Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: * Active RN license in the state where you'll be working and living * 2+ years of RN experience * 1+ year of experience in critical care, acute care, or home healthcare * Strong skills in IV insertion * Valid driver's license * Willingness to travel to patients' homes within a large geographic region * Ability to do multiple patient visits per week (mostly weekends, but may also include weekday evenings, per business need) * Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 36 - 61 USD / hourly, depending on relevant factors, including experience and geographic location. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Aligned with a team of Cigna Healthcare Sales Professionals, the Dental Sales Executive (DSE) is positioned as the new business market leader for dental and vision products. The DSE is responsible for selling dental and vision products within their aligned market space. Distribution of these products are through three main channels, dental/vision standalone; packaged with medical; and upselling off existing medical relationships. The aligned DSE will need to find the best path to maximize all distribution channels. The individual needs to be very knowledgeable of our dental and vision line of product and services. This is a ‘hunter' role and requires a minimum of five years of industry experience. Market Strategy Responsibilities Sell new dental and vision business within aligned market assignment. Assume singular responsibility for overall dental growth plan, balancing membership needs and profit levers Meet or exceed growth plan as measured by new membership. Manage the dental sales process for all opportunities to identify the pathway to win and develop a strategy that drives the best outcome. Weekly updates of the dental pipeline tool. Consult on vision sales opportunities. Review and respond to RFP's by coordinating with internal matrix partners (underwriting, proposal unit, network etc.). Externally present financials and capabilities to the market. Oversee implementation of new dental and vision accounts. Develop and execute a business development plan focused on dental and vision. Plan should be focused on broker development, prospecting and building a strong market presence. Collaborate with aligned Cigna Healthcare Middle Market sales team; develop and implement short and long-term sales strategies for local market; focus on brokers/consultants, prospecting and driving vertical growth (Government Sector, Hospital and more). Develop and execute a prospecting plan focused on the following verticals: Government & Education, Hospital and other avenues. Attend Monthly Business Review sessions with matrix partners, review pipeline, discussion broker development plans and prospecting efforts. Use this meeting to discuss any marketplace needs that are needed to succeed. Use insight into customer needs, local competitive landscape and independent judgment to work with the Dental Organization to drive industry leading Dental Products, Networks and Pricing. Build collaborative partnerships by actively participating in local market management discussions (e.g., growth calls, local strategy development meetings, etc.) Understand competitive and market-level dynamics and implications; independently recognize those that must be brought back to Dental Senior Management Team Maintain all-encompassing knowledge and proficiency in CIGNA Dental's products and capabilities; accomplish this through attendance and active participation in ongoing monthly dental information sessions, monthly dental operating results reviews, training programs, etc. Provide dental updates and training to CIGNA Healthcare sales partners, Producers and Clients Through superior coaching skills, aggressively and proactively promote new dental products and features; provide ongoing coaching to the CIGNA Healthcare sales partners on Dental product positioning and techniques on how to sell against top market competitors Qualifications College Degree or years equivalent related experience. 5+ years' experience in Dental benefits. Proven healthcare sales experience is required, managed dental sales experience is strongly preferred. Ability to work strategically with matrix partners to design presale strategies and proposals, as well as problem solve and bring industry intelligence to create new solutions Licensed producer Acceptable driving record with ability to travel frequently and with short notice. Ability to work independently in a complex environment requiring “real time” judgment and discretion, strong analytical skills, common sense, decisiveness and assertiveness. Strong influence skills and ability to work cooperatively with others in a highly matrixed environment. Excellent communication, customer service skills and sales negotiation skills. Financial Savvy; membership growth orientation Excellent interpersonal, communication and negotiation skills, including well-honed public speaking, presentation and writing skills. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. This role is also anticipated to be eligible to participate in an incentive compensation plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Staff Pharmacist - Freedom Fertility by Evernorth Join our expert team at Freedom Fertility Pharmacy in Newburyport, MA, where your clinical skills and passion for patient care make a real impact. As a Staff Pharmacist, you'll play a vital role in ensuring safe, accurate, and compassionate medication management for patients navigating complex fertility treatments. If you thrive in a fast-paced, collaborative environment and want to contribute to life-changing outcomes, this is your opportunity to grow and lead with purpose. Location: This position is located onsite at our Newburyport, MA location. Schedule: The shift for this position is (4) 10-hour shifts per week rotating Monday through Friday: 3 days 10:30 am - 9 pm ET and 1-day 9 am - 7:30 pm ET. Weekend Rotation: There is also a Saturday rotation from 9 am - 6 pm ET every 10th weekend and Saturday 9 am- 6 pm ET and Sunday 10 am -4 pm ET rotation every 20th weekend. *When working the Sat and Sat/Sun weekend rotation, you would have a weekday(s) off the following week. On-Call: A 2-week on-call rotation required one time per year. Responsibilities Ensure accuracy and compliance in interpreting and verifying prescriptions, supporting patient safety at every step. Provide clinical oversight and quality assurance for sterile and non-sterile compounding processes. Lead environmental monitoring and maintain cleanroom standards to uphold the highest quality benchmarks. Partner with pharmacy technicians and cross-functional teams to optimize workflow and deliver exceptional service. Consult directly with patients to educate on medication use, potential interactions, and best practices for treatment success. Drive operational excellence by managing timelines, adapting to changing priorities, and mentoring less experienced pharmacists. Required Qualifications Current active pharmacist license in good standing. Minimum 2 years of experience in a clinical or specialty pharmacy setting. Proven ability to interpret prescriptions accurately and ensure compliance with regulatory standards. Strong problem-solving skills and ability to collaborate across teams. Excellent communication skills and commitment to patient-centered care. Preferred Qualifications Experience in sterile compounding and fertility pharmacy. Familiarity with environmental monitoring and cleanroom protocols. Ability to work flexible schedules, including occasional weekends and on-call rotations. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 53 - 89 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

About Fallon Health: Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation's top health plans for member experience and service and clinical quality. Brief Summary of Purpose: The Accountable Care Organization (ACO) Behavioral Health Case Manager (BHCM) is an integral part on an interdisciplinary team focused on transition of care assessment and support, care coordination, care management and improving access to and quality of care for Fallon Health ACO members. The BHCM embeds in the ACO Partner Provider Offices and works closely with ACO Partner Providers, Office Staff, Care Management Staff and others at the Partner sites managing member care. BHCM seeks to establish telephonic and/or 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 developed by the BHCM and Care Team. Responsibilities may include conducting in home/office face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The BHCM conducts assessments and refers members to Community Partner Programs such as Behavioral Health and Long-Term Services and Supports. The BHCM may also refer members to Flex Program as applicable depending upon the ACO the member is affiliated with. The BHCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Responsibilities include: Member Assessment, Education, and Advocacy * Telephonically assesses and case manages a member panel * May conduct in home face to face visits for onboarding new enrollees and reassessing members, utilizing a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a Member's clinical/functional status to identify ongoing special conditions and develops and implements an individualized, coordinated care plan, in collaboration with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome * Performs Care Transitions Assessments - per Program and product line processes * Maintains up to date knowledge of Program and product line benefits, Plan Handbook Benefits and Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights * Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners * Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives * Assesses the Member's knowledge about the management of current disease processes and medication regimen, provides teaching to * increase Member/caregiver knowledge, and works with the members to assist with learning how to self-manage his or her health needs, social needs or behavioral health needs * Collaborates with appropriate team members to ensure health education/disease management information is provided as identified * Collaborates with the interdisciplinary team in identifying and addressing high risk members * Ensures members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team * Strictly observes HIPAA regulations and the Fallon Health Policies regarding confidentiality of member information * Supports Quality and Ad-Hoc campaigns Care Coordination and Collaboration * Provides culturally appropriate care coordination, i.e., works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers, and/or authorized representatives * With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs while completing program assessments and working with the member to approve their care plan * Manages ACO members in conjunction with the Nurse Case Manager, Navigator, Social Care Managers, ACO Partners, Community Partners, Behavioral Health Partners and others involved/authorized in the member's care * Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member's health care goals and needs * Works collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process * Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining the focus of the Member's healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care * Actively participates in clinical rounds * Ensures timely filing with the appropriate Protective Services agency regarding any concerns about the safety and well being of a member * Maintains an ongoing awareness of community clinical, psychiatric, and other outpatient resources as well as state and federal resources as needed Provider Partnerships and Collaboration * May attend in person member/provider visits, care plan meetings with providers and office staff and may lead care plan review with providers and care team as applicable * Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met Regulatory Requirements - Actions and Oversight * Completes Program Assessments, Notes, Screenings, and Care Plans in the TruCare and Provider EMR systems according to Program policies and processes Provides training and consultation * Serves as a behavioral health consultant to the Fallon Health Clinical Integration Team * Offers recommendations to continued program development and is an active participant in suggesting opportunities to enhance the program * Works with Fallon Health Provider Relations and Beacon Health Options to ensure that contracted behavioral health providers are knowledgable about the plan benefits, eligibility requirements, and care coordination and communication needs * Coordinate with Beacon staff to ensure quality and timely arrangement of necessary mental health and substance use supports. * Attends Fallon Health/Beacon meetings when requested * Attends supervision and 1:1 meetings with Leader. Attends Team Huddles, staff meetings, site meetings and other Fallon Health and business related meetings as required. Meetings may be in person or telephonic depending upon the need Other * Performs other responsibilities as assigned by the Manager/designee * Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee Qualifications Education Master's degree from an accredited school of social work, mental health counseling, psychology, or human services required. License: Active, unrestricted license as a LCSW, LICSW or LMHC; reliable transportation Certification: Certification in Case Management a plus Other: Satisfactory Criminal Offender Record Information (CORI) results. This role requires compliance with the ACO Partner Health and Educational requirements. Performance Requirements including but not limited to: * Ability to conduct behavioral health assessments, develop and implement comprehensive care plans that addresses the member's behavioral health needs in conjunction with their medical needs and social determinants of health * Ability to serve as a member on an interdisciplinary care team that may include the member's primary care physician, medical providers, behavioral health providers, state agencies and/or internal nurse case managers and navigators * Ability to screen and assist members with social determinants of health including but not limited to relevant food, housing and state applications (e.g., DDS, DYS, DCF, DMH) * Experience with subpopulations including children, adolescents, the homeless, those with SPMI, substance use disorders, and disabilities * Effective case management, care coordination, and member advocacy skills * Knowledge about behavioral health community resources, levels of care, and criteria for levels of care * Familiarity with motivational interviewing and harm reduction to engage and connect with members * Ability to work collaboratively with BH vendor * Familiarity with software systems including but not limited to Microsoft Office Products - Excel, Outlook, and Word Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $92,000 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.

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: Serve as key resource for internal and external customers providing guidance and information on contractual matters to ensure requirements for contracts are met. Ensure all relevant contract documents are in compliance with respect to company policies, federal and state regulations. Facilitate contracting through interactions and correspondence with internal business owners, Compliance, IT Security, MassHealth, SCO, Regulatory Affairs and legal counsel as appropriate. Work collaboratively with FCHP business owners on vendor contract bid preparation, analysis and amendment processes including supplier recommendations and preparation of final contracts. Maintain the established process for FCHP vendor contracts - ensure all key vendor and terms are included and easily reportable. Research renewals of existing contracts in a timely manner, working with business owners to confirm use of product or service. Ability to handle a high volume of work in a team-based environment that consistently meets deadlines. Excellent organizational and time management skills including the ability to manage multiple projects. Responsibilities Primary Job Responsibilities Contract Administration: Manage a central vendor contract database/file that includes information on contract terms and deliverables. Assist the Director in managing new contracts from start to completion through uploading to contract repository. Independently review, prepare, negotiate, and execute a significant number of operational contracts, including but not limited to, Confidential Disclosure Agreements, Master Services Agreements, Statements of Works, Task Orders, Work Orders, Data Transfer Agreements, Consulting Agreements, Business Associate and Amendments and Requests for Proposals. Track and report all contracts and significant provisions, including termination dates, renewal dates, Certificates of Insurance, Statement of Controls Reports, etc. Vetting of new suppliers as part of contracting process to include reference checks and vendor's financial status as applicable. Ongoing vendor management to ensure all contract terms and conditions including regulatory and compliance related requirements are being met. Perform all aspects of contract lifecycle processing with necessary accuracy of order entry data, and necessary focus on contract funding, scope changes, contract amendments, delivery, legal requirements, etc. Procurement Activities: Assist with the continuing development and coordination of purchasing policies, procedures, and workflow. Assist with the ongoing centralization of the procurement function and maintaining an efficient and effective centralized procurement system. Lead efforts in identifying goods and services that could be run through reverse auctions for price compression. Work with reverse auction house(s) to schedule and run those events. Work with FCHP business owners on vendor contract negotiations to obtain best possible value for the Company prior to issuance of a PO Responsible for developing RFP's and leading most RFP processes. Monitor compliance with all purchasing agreements to ensure maximum cost savings. Work with FCHP designated staff on the purchase order process. Independently audit available Company information (ie - vendor invoices) to identify cost saving opportunities. Review and assign purchase requisitions to internal buying staff. Coordinate purchasing activities within organization. Support and assist with other Purchasing functions Expense Control Activities: In conjunction with the Director of Procurement and Strategic Cost Analysis, we perform the following functions: Promote the development of expense control / cost discipline programs across the organization. Oversee and influence purchasing decisions across the organization and particularly within IT and facilities. Analyze Vendor invoicing and payment information to assist business owners in resolving any conflicts. Oversee and maintain select policies and procedures (e.g. New Vendor Onboarding, Corporate Purchasing, and others as identified through the course of work) as requested by the Director. Assist the Director by leading vendor negotiations on existing and new engagements. Other Activities: Conduct all business using strong interpersonal skills and excellent methods of communication across all levels of the organization and with vendors, and other stakeholders. High degree of self-motivation required to independently perform assignments, for example: Meet or exceed expected expense/procurement saving targets Monitor and analyze the execution of programs, conduct complex schedule analyses, earned-value analyses, and change management evaluation, makes/recommendation resource allocation and budget adjustments. Participate in vendor selection activities and challenge the status-quo regarding all aspects of the negotiation activity. Coordinate and implement financial analysis for identifying and tracking expense savings opportunities. Perform special projects and ad-hoc requests as needed from time to time. Qualifications Qualifications requirements Education: BS in Business Administration preferred or equivalent experience Experience: 5+ years contract management, procurement and product management experience is required. Strong knowledge of procurement practices and contract management. Experience negotiating software licensing and consulting services. Contracting and Purchasing experience in healthcare or medical field is a plus. Oracle Cloud ERP experience is preferred. Competencies: Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision. Specific competencies essential to this position: Adaptability Team oriented Builds relationships Works independently Excellent written & oral communication skills Analytical ability Problem Solving Strong negotiating skills Advanced proficiency in Microsoft Word and Excel Ability to deal tactfully and diplomatically with staff at all levels 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. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is$ 100,000-$ 115,000 annually 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. Not Ready to Apply? Join our Talent Community now!

**Home Infusion Registered Nurse - Accredo** **Patient visits for this position will mostly be on the weekends, and possibly some evenings. However, some weekday availability will be required, especially during training.** Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo by Evernorth has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. **How you'll make a difference and improve lives:** + Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. + Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. + Provide follow-up care and manage responses to ensure their well-being. + Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. **Requirements:** + Active RN license in the state where you'll be working and living + 2+ years of RN experience + 1+ year of experience in critical care, acute care, or home healthcare + Strong skills in IV insertion + Valid driver's license + Willingness to travel to patients' homes within a large geographic region + Ability to do multiple patient visits per week (mostly weekends, but may also include weekday evenings, per business need) + Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 36 - 61 USD / hourly, depending on relevant factors, including experience and geographic location. **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

**This is a permanent work from home position within the state of Arizona, or onsite in Massachusetts.** + Ready for a job that encourages you to use your communication and problem-solving skills? If so, prepare to use those skills to help your patients' dreams of having a family come true! As a **Customer Service Representative - Refill Pharmacy Technician** at Freedom Fertility, you'll use your empathy and listening skills to handle inbound calls from patients and learn more about their medical history and challenges with fertility. This is not your average customer service job - you'll work for a company that truly cares about people while helping our patients achieve happiness. **Here's a little more on how you'll make a difference:** + _Ensure process efficiency_ - Work with both patients and physicians to coordinate fertility plans and medications. Own the patient experience through resolving customer issues and ensuring 100% follow-up to customers. + _Pay attention to detail_ _-_ Accurately obtain and enter patient information, including shipping, insurance, and payment information. + _Be a team player_ - Escalate complex claims to the Sr. Billing & Reimbursement Specialists for appropriate action. **Why join us?** + Health coverage effective day 1 (including medical, dental, vision) + Holiday, PTO, and OT pay + 401K with company match + Tuition reimbursement + Fun, friendly, and unique culture - bring your _whole_ self to work every day! **What you need to do the job:** + If residing in AZ - a valid CPhT license + If residing in MA - a valid MA Tech license Preferred CPhT + Excellent customer service, organization, and time management skills + High School Diploma or GED required + PC skills including knowledge of Microsoft Office Suite and Internet + Must reside within the state of **Arizona** or within driving distance of **Newburyport, Massachusetts** If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 17.75 - 19 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group . **About Evernorth Health Services** Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _*********************_ _for support. Do not email_ _*********************_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._

This Intake Administrator position is in the Appeal and Grievance Department and may require training in our Worcester office 5 days/week from 8 am to 5 pm up to 6 months before working a hybrid schedule. Must be able to type 25 WPM. 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 or purpose: Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative support to the department. Responsibilities • Administer FH Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable NCQA standards and other state or federal regulatory requirements. Strict adherence to department turn-around time standards established in accordance with regulatory standards is required. • Act as the initial investigator and contact person for member grievances and appeals, which includes, sending the appropriate acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal.• Print, mail, and triage letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA.• Identifying the need for Personal Representative Authorization form, Medical Record Release Authorization form, or Provider Payment Waiver form and requests such documentation as necessary.• Assigning case files to the department staff for case management.• Managing incoming faxes and member specific data, routing to the appropriate staff member. • Producing, maintaining, and distributing reports/calendars utilized by the team to assist in workload planning.• Processes department incoming/outgoing mail per established workflows in a timely and accurate manner.• Providing administrative/clerical support to the department which may include acquisition of medical records from providers.• Retrieving messages from email and voice mailbox, routing to the appropriate staff member.• Photocopy and compilation of appeal case file when necessary.• Completion of request for additional information from external review agency.• Responsible for additional clerical/administrative responsibilities at the discretion of the Director or Manager.• Providing administrative assistance in support of the Board of Hearings (BOH) process, including preparation of hearing packets, reviewing of materials, as well as tracking and monitoring hearing decisions.• Ensure that all grievances/appeals are processed in adherence to state and federal regulations (i.e., CMS, MassHealth, OPP), contractual obligations, NCQA guidelines and FH policy. Qualifications Education: College Degree (B.S. or B.A.) or equivalent License/Certifications: Reliable transportation required Experience: 2 years college education (or knowledge of healthcare field equal to 2 years college preparation) Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $21 - $22/hour, 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. #P03

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 NaviCare is a program for people age 65 and older, who live in our service area, and who have MassHealth Standard, and may have Medicare. It combines MassHealth (Medicaid) and Medicare benefits, including prescription drug coverage. 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: This position requires that the Account Executive achieves personal referral and outreach goals for the NaviCare program. Manages a territory and group of referral source accounts, providing regular follow up and overcoming barriers with each account to meet enrollment goals. Responsibilities Primary Job Responsibilities: 1.Relationship Building Creates productive and collaborative relationships with internal and external referral sources in order to obtain qualified referrals and enrollments for the NaviCare program. Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events to ensure Fallon Health's visibility and presence in your territory. Presents the NaviCare program to groups who are likely prospects, caregivers and community referral sources. Develops and implements their own territory business development plan and carries out activities to penetrate accounts listed on the plan. 2.Lead Generation Works collaboratively with Navicare enrollment team to discuss progress of referrals and ideas for resolving issues. Provides inservice orientations to vendors and providers on an annual basis. Shows accountability and follows up with prospects until the lead is closed/withdrawn and document as appropriate. Achieves monthly referral and home visit request goals 3.Secure Applications Generates sufficient NaviCare enrollment applications to meet monthly enrollment goals. Explains the NaviCare program clearly and consistently to prospects and their families to ensure that prospects enroll with a solid understanding of the program maintaining a low disenrollment rate. Meets with NaviCare prospects in their homes. Completes application and other documentation needed. Submits all completed applications in a timely manner as required by CMS. 4.Tracking & Reporting Documents all sales activities in the department's CRM application and account management grid in a timely manner. Meets weekly sales activity deliverables consistently, and tracks these in the CRM and their Outlook calendar. Maintains records of NaviCare applications and documentation related to scope of appointments. 5.Assessment Regularly reviews effectiveness of efforts against goals. Provides market intelligence to the NaviCare/ Manager and the Outreach Director so that adjustments can be made to tactical plans. Manages their own professional development by seeking advice, training, and coaching from their colleagues, manager, and the Director of Outreach. 6.Regulatory Guidelines Operates within the marketing and outreach guidelines and regulations provided by CMS and EOHHS. Retains Scope of Appointment and other Enrollment Records. Submits information on NaviCare prospect events to Outreach Support in a timely manner, for CMS submission. When in doubt, asks questions pertaining to compliance or privacy regulations. Must meet monthly, quarterly and year end enrollment goals. Must maintain a mininimum number of activites and event designed to generate leads for enrollments. Must keep up to date all records related to leads in CRM system, Account Management Grid and any other report requested by your manager. Must cause to have at minimum 10 actively referring account. Must work to develop at least 10 new accounts every month. Must attend all required Department and collaborating Department meetings. Must complete and deliver on time reports, documentation, and yearly business plan for your territory. Qualifications Education, BS or BA degree and/or comparable experience Certification and Licenses: Must have or obtain within 90 days of hire date Massachusetts Insurance Producer License Obtain AHIP certification before or after hire Experience: Knowledge and experience working with community organizations, low income communities and the elderly 3 years of sales experience in healthcare or group insurance strongly preferred. Must have proven experience working in a customer facing role focused on sales, lead generation in a high paced customer service or sales environment. Knowledge of Medicare, Medicaid and insurance products is desirable. Knowledge of customer service, sales, outreach and marketing principles and practices. Possession of a valid Mass. driver's license and a vehicle to be used for marketing activities and home visits. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $65,000 - $70,000 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. #P02 Not Ready to Apply? Join our Talent Community now!

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: Performs a variety of duties involving clinical and administrative patient care in accordance with applicable standards of practice. Provides assessment and care to PACE participants at the direction of the SE Clinic Supervisor, SE Clinical Manager and/or the SE Provider. Responsibilities Primary Job Responsibilities: Prepares and stocks exam rooms Rooms participants in the SE PACE clinic Assists in the examination and treatment of PACE participants under the direction of the SE Provider (physician or NP) Obtains and records vital signs including blood pressure, heart rate, temperature, pulse oximetry, heights, weight, etc. Assists with simple to complex clinical/diagnostic procedures such as urine cultures, throat cultures, etc. Establishes IV access as requested and necessary under the direction of the SE Provider (EMT-Advanced) Performs phlebotomy as ordered by the SE Provider Performs point of care testing as ordered by the Provider both at the PACE center and in the community Performs EKG, bladder scan and Doppler as ordered by the Provider Conducts home visits when needed to medically evaluate and treat PACE participants in their homes under the direction of the SE provider and within the established standards of practice of their relevant license or certification Administers medication (within scope of practice), wound care, breathing treatments and other procedures at the direction of the SE Provider both at the PACE center and in the community for PACE participants Qualifications Education: High School Diploma/GED Successful completion of Massachusetts EMT-Advanced or CCT program or Medical Assisting Certificate or 2 years' equivalent experience as Medical Assistant/Clinical Assistant in busy medical practice License/Certifications: Licensed as an Emergency Medical Technician-Advanced in the State of Massachusetts or; Certification as a Critical Care Technician or; Proficiency in phlebotomy and Medical Assisting responsibilities as would have been gained through experience as Clinical Assistant or Medical Assistant in busy medical practice Successful completion of Basic Life Support (BLS-CPR) Healthcare Provider Experience: At least two years' relevant clinical assisting experience in busy medical practice or similar setting Experience working with the frail elderly population Knowledge of medical office and laboratory procedures Ability to perform phlebotomy procedures independently Ability to gain IV access independently (EMT-Advanced only) Ability to practice independent judgement in accordance with applicable standards of practice Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $21.00 to $23.00 per hour, 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. #P02 Not Ready to Apply? Join our Talent Community now!

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: With the general direction from the VP Sr. Medical Director Clinical Management and SVP/Chief Medical Officer will provide strategic leadership and oversight responsibility for the clinical and operational utilization management activities for all inpatient and outpatient care, and staff across all product lines. Responsibilities Utilization Management: Oversees all administrative, operational and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent review and discharge planning. Ensures that members get the appropriate care that is medically necessary and meets the benefit coverage criteria. Ensures that all reviews meet the appropriate regulatory and accreditation requirements including turnaround times and communication. Ensures program compliance with all federal regulatory and state mandates, Division of Insurance, National Committee for Quality Assurance standards, Centers for Medicare and Medicaid guidance and requirements, MassHealth (Medicaid contractual agreements). Responsible for hiring appropriate non-physician clinical and non-clinical personnel to review medical cases and determine if requests for services meet medical necessities and criteria for coverage. Oversight of UM by delegated organizations and ensure regulatory and accreditation compliance, Monitors and analysis of operational and outcome data related to all utilization management activities. Recommends and implements innovative process improvements for the prior authorization and utilization management processes Develops and implements the Utilization Management Program Description and annually evaluate the effectiveness of the program. Represents the UM Department in Program Audits across all LOBs, including information gathering, research, presenting, and development of Corrective Action Plans (if applicable) Key Contact for RFP responses related to UM Functions and department organization structure/staffing. Works with VP/Medical Director to identify and prioritize the cost of care opportunities related to Utilization Management. Works with VP/ Medical Director to set agenda related to UM and represent the plan at clinical joint operating committees to support collaborative Fallon/provider group relationship. Manages data, predictive analytics to improve efficiency of prior authorization and utilization management Works with and represents Care Services for utilization management on the different product line task forces at Fallon. Serves as SME and Point of Contact for internal committees including but not limited to Delegation Oversight Committee (DOC), Payment Policy, Mental Health Parity, Medical Directors monthly meeting, and TruCare Insights/upgrade meetings. Represents the Vice President and Senior Medical Director of Clinical Management at internal and external senior level meetings. Budget creation and management of annual budget. Clinical Integration Support: Provides UM expertise to Clinical Integration leadership to ensure seamless integrated member care within Care Services as well as other departments by involving inpatient case management with out-patient case management and utilization management to optimize post-acute care. Manage and develop staff: Ensures objectives defined across a broader group are integrated and supportive where necessary. Defines roles and accountabilities for staff, within the group and in the context of the broader process/operation in support of cross-functional efforts. Hires for, develops and recognizes the experience and knowledge/skills/abilities required for a successful team. Provides for the orientation and welcome of new staff. Defines performance expectations and goals for staff. Trains and mentors' staff on the application of policy and procedures, use of supporting systems/applications, appropriate soft skills: time management, etc. Monitors work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to staff. Evaluates staff on achievement of goals and deliverables and assessment of competencies. Helps staff progress in their careers to the benefit of the department and broader organization. Manages the resolution of performance issues in consultation with Human Resources as appropriate. Qualifications Education: Master's degree in health administration or business preferred. Bachelor's degree in nursing or related health field required. License/Certifications: Massachusetts Nursing Licensure Experience: Broad experience in managed care and /or integrated delivery systems, either payer or provider. Significant experience in regulatory and accreditation compliance requirements for Medicare, Medicaid and the division of insurance support all Fallon Health Products Experience in managing health care and support personnel, as well as managing health care personnel and external relationships. A comprehensive knowledge of utilization management strategies to manage utilization and costs. Minimum of ten years clinical experience, at least five in managed care or ambulatory clinical operations. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $155,000 - 175,000 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. #P01 Not Ready to Apply? Join our Talent Community now!

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 of Summary of Purpose: Responsible for processing, verifying, and reconciling Accounts Payable invoices. Responsibilities Primary Job Responsibilities: AP processing for FCHP and overall functionality of Oracle AP Enter/Scan all accounts payable invoices into Oracle and analyze and pay vendor accounts according to invoice terms, either PO or GL account costing Ensure AP invoice and backup approvals attached to payment Assist with AP inquires Assist with incoming mail, distribute accordingly Upload other multi line AP requests into Oracle Financials / Record all ACH/Wire payments Submits payment to bank, confirms positive pay Assist with requests from Internal Audit with Model Audit requests Assist the Director of accounting Operations with ad hoc projects Qualifications Education: Associate degree in accounting or equivalent work experience. Experience: 1-2 Years' experience working in an accounting dept- specific Accounts Payable processing preferred. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 55,000 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.

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: Functions as a member of the PACE Interdisciplinary Team and provides social work services and support to participants, families, and other caregivers. Provides direction to bachelor's level social workers as assigned by Social Work Manager. Why should I consider a Social Work opportunity in a PACE program at Summit? Great Pay! LICSW supervision offered to advance licensure. Anchor position Great Benefits - including very affordable Health Insurance! 23 days of PTO - and - an additional 12 Holidays Monday to Friday from 8:30 AM - 5:00 PM No Holidays! Some wonderful relationships established with the participants you care for! Manage a caseload of only 65 participants in collaboration with your team which includes a provider and primary care nurse. Assessments completed only semi-annually or for a significant change Assist with the supervision and training of MSW student interns And many, many more! Responsibilities Primary Job Responsibilities: • Participates in the intake and evaluation process by conducting the initial social work assessment, administering MSQs, developing an intake summary and presenting the social work perspective to the interdisciplinary Team. • Assures that participants rights are reviewed during the intake process. • Conducts reassessments at least semiannually and whenever there is a change in participant status or the participant /caregiver requests it. • Develops and implements a social service plan of care for each participant and updates it based on the results of reassessments or on-going changes in status. • Responsible for the maintenance of appropriate records and documentation in the medical record including at least the initial assessment, quarterly progress notes, significant changes and all participant-related interactions. • Participates as a member of the Interdisciplinary Team at daily team meetings and care planning meetings. • Assists team members to understand the social, emotional, cultural and psychosocial aspecst of participants' situations. • Acts as an advocate and liaison when counseling services are needed. • Completes documentation and record-keeping related to disenrollment's, deaths and permanent placement; distributes relevant notifications. • Participates in the development, promotion and implementation of caregiver support groups or programs; leads or co-leads groups as necessary. • Assists in managing referral telephone calls as needed. • Implements program policies and procedures as directed. • Assists in the conversion of participants from community based Medicaid to long-term care Medicaid when necessary. Works collaboratively with the Operations Support Representative to assure appropriate access to Medicaid benefits. • Pursues relevant professional development. Attends appropriate workshops and in-service activities to maintain current professional status. • Consistently follows the Social Work Code of Ethics. • Performs all duties in accordance with FCHP and Summit ElderCare policies and procedures. Qualifications Education: Master's degree in social work License/Certifications: Valid and unrestricted license to practice social work from the Board of Registration of Social Work of the Commonwealth of Massachusetts. Access to reliable transportation to perform work throughout the PACE center's service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage Experience: At least two years experience in a Social Work capacity, preferably in a community setting, with a minimum of one year experience working with a frail or elderly population. Generally, establishes own work plan and priorities, using and/or modifying established procedures, to assure timely completion of assigned work in conformance with program policies and standards; problems lacking in clear precedent are reviewed with Manager prior to acting. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $ 85,000, 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. #P01

Home Infusion Registered Nurse - Accredo Specialty Pharmacy Take your nursing skills to the next level by helping to improve lives with Accredo Specialty Pharmacy, a division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it's about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You'll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You'll get the opportunity to make a lasting impact on the lives of others. How you'll make a difference and improve lives: * Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients' needs are met and to help them achieve their best health. * Administer Medications: Take full responsibility for administering IV infusion medications in patients' homes. * Provide follow-up care and manage responses to ensure their well-being. * Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey. Requirements: * Active RN license in the state where you'll be working and living * 2+ years of RN experience * 1+ year of experience in critical care, acute care, or home healthcare * Strong skills in IV insertion * Valid driver's license * Willingness to travel to patients' homes within a large geographic region * Ability to work 40 hours a week (can include days, evenings, and weekends, per business need) * Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 76,900 - 128,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Overview 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 Navigator 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 partners with Fallon Health Care Team staff and other providers to always communicate what is occurring with the member and their status. The Navigator seeks to establish telephonic and face to face (depending upon product and circumstance) relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member specific care plan. To effectively advocate for member needs, the Navigator may make in home or facility visits (depending upon the product and circumstances) with or without other Care Team members to fully understand a member's care needs. Responsibilities include but are not limited to: * Utilizes an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction * Conducting telephonic and may conduct face-to-face member visits to assess members utilizing TruCare Assessment Tools * Establishing and developing effective working relationships with community partners such as housing staff, adult day health care staff, assisted living staff, group adult foster and adult foster care staff, rest home staff, long term care facilities and other providers including primary care providers with the goal to facilitate member specific communication, represent Fallon Health in a positive and effective manner, and work to grow membership in the various Fallon Health products as applicable * Educating members/PRAs about their product specific benefits and how to access often times facilitating and coordinating such * Help 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 a 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 * 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 * Help 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 NaviCare Member Population: Facilitates transportation to medical, behavioral health, and social appointments by educating the member about the process to request transportation and/or working to assist the member to obtain such * 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 * 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 Partners for intervention based upon criteria and processes * If working on the ACO or Commercial Products and depending upon process: May contact maternity members after hospital discharge to facilitate delivery of items as part of the 'Oh Baby' program and work with Nurse Case Managers to coordinate after care needs * The Navigator refers to the Nurse Case Manager/PCP whenever clinical decision making is required. Responsibilities Note: Job Responsibilities may vary depending upon the member's Fallon Health Insurance Product * Member Education, Advocacy, and Care Coordination * Utilizes an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction * Performs tasks and actions to ensure all CMS and State member related regulatory mandates are met including but not limited to welcome calls, care plans, health risk assessments/care needs screening for the member population, and member service plans according to Program Policy and Process for the particular member product * Monitors the daily inpatient census and notifies all members of the care team during member care transitions including any discharge planning updates depending upon the product process * Works collaboratively with Embedded Navigators and Transition of Care Team RNs * Follows up with members following transition of care to ensure member attended follow up appointments, if they have any questions or concerns, and ensures all members of the Care Team are knowledgeable about the care transition and work collaboratively to ensure the member care plan meets needs * May conduct visits to hospital and Nursing Facilities during a Care Transition to participate in the discharge planning process (depending upon the product and circumstances) * May perform home visits with members (depending upon the product and circumstances). Visits may be by self, or with others on the Care Team * Responds promptly to member calls/questions and follows up per department processes at all times demonstrating exceptional customer service skills in a culturally sensitive way * Provides culturally appropriate care coordination i.e.: arranges for interpreters, provides communication documents in appropriate language, demonstrates culturally appropriate behavior when working with member/family * Develops and fosters relationships with members and providers/facilities and depending upon the product, to be the first point of contact for benefit related questions and is able to explain processes including but not limited to: coverage criteria, appeal rights and processes, authorization request process, formulary, and evidence of coverage details * Manages member panel in conjunction with other employed Clinical Integration Team members; depending on the Fallon Health product, with the contracted Aging Service Access Point Geriatric Support Service Coordinator when applicable; and/or Community Partners; and contracted primary and specialty care providers - this includes conducting face to face or telephonic health risk assessments in a culturally sensitive way, completing care plans, and reviewing claims and other data which may indicate a need for Nurse Case Manager involvement and assessment * Assists the interdisciplinary team in identifying and addressing member barriers related to social determinants of health and care obtainment * Collaborates with the interdisciplinary team in identifying and addressing high risk members and transitions of care * Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through community senior/cultural centers and other external partners * Maintains up to date knowledge of Program/Product benefits, Plan Evidence of Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights * Participates in member retention efforts by providing benefit advice and clarification upon knowledge of member dissatisfaction and potential to voluntarily leave the plan, as applicable * Collaborates with appropriate team members to ensure health education/disease management information is provided as identified * Educate members on preventative screenings and other health care procedures such as vaccines and screenings according to established protocols * Provider Partnerships and Collaboration * May attend in person care plan meetings with partners and providers and leads care plan review with partners and providers and care team * Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met * Ensures accurate membership reports based upon provider/facility, distributes reports ensuring accuracy of data, updates and maintains provider sheets as applicable * Access to Care * Depending upon the product, generates requests and authorizations for Medicaid covered services per the member care plan ensuring all services requiring authorization have accurate and timely authorizations in place in the Fallon Health system with accuracy and timeliness per program process depending upon the member product and workflows * Educates members and providers on authorization processes, educates about authorization review outcomes, works to resolve authorization related issues and concerns depending upon the member product and workflows * Follows through to ensure services/authorizations are in place as per the care plan, and if not, takes action for successful resolution * Facilitates member access to Program benefits, providing education about coverage criteria, explaining processes for member request determinations and helping members navigate the managed care system * Care Team Communication * Follows established transition of care workflow including but not limited to: communicating to all members of the Care Team when a care transition occurs and documents per workflow * Works collaboratively and ensures communication with members of the Care Team including but not limited to, medical providers, and member/PRAs to ensure member care plan supports their needs * If working on the NaviCare product line, partners with the Long Term Care Team/Community Team when members are admitted to custodial care and/or discharged to the community to ensure admission and discharge planning needs for the member are met * May partner closely with the Advanced Practitioner staff to ensure facility and member needs are being met * Regulatory Requirements - Actions and Oversight * Depending upon member product, performs tasks and actions to ensure all CMS/State/NCQA related regulatory mandates are met including but not limited to Care Needs Screenings, Welcome Calls, Care Plans, Health Risk Assessments, and member Service Plans according to Program Policy and Process * Completes timely Care Needs Screening, Health Risk Assessments, Service Plans, and Care Plans in the TruCare system (care management platform) according to Regulatory Requirements and Program policies and processes Qualifications Education: High School Diploma or GED required. College degree (BA/BS in Health Services or Social Work) preferred License/Certifications: Other: Satisfactory Criminal Offender Record Information (CORI) results and access to reliable transportation Experience: * 2+ years job experience in a managed care company, medical related field, or community social service agency required * Understanding of hospitalization experiences and the impacts and needs after facility discharge required * Knowledgeable about medical terminology and basic understanding of common disease processes and conditions required * Knowledgeable about medical record documentation and able to recognize triggers requiring RN intervention required * Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking required * Understanding of the impacts of social determinants of health required * Knowledgeable about software systems including but not limited to Microsoft Office Products - Excel, Outlook, and Word required * Experience working in a community social service agency, skilled home health care agency, community agency such as adult foster care, group adult foster care, personal care management agency, independent living agency, State Agency such as the Department of Mental Health (DMH), Department of Developmental Services (DDS), Department of Children and Families (DCF), and/or the Department of Youth Services (DYS), or other agency servicing those in need preferred * Experience in a nursing facility or in a Massachusetts Aging Access Service Point Agency preferred * Experience working on a multi-disciplinary care team in a managed care organization preferred Performance Requirements including but not limited to: * Excellent communication and interpersonal skills with members and providers via telephone and in person * Exceptional customer service skills and willingness to assist ensuring timely resolution * Excellent organizational skills and ability to multi-task * Appreciation and adherence to policy and process requirements * Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education * Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties * Willingness to learn about community resources available to assist the member population in the community and long term care settings and demonstrated willingness to seek resources and expand knowledge to assist the population * Willingness to learn insurance regulatory and accreditation requirements * Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables * Accurate and timely data entry * Effective care coordination skills and the ability to communicate, advocate, and follow through to ensure member needs are met * Knowledgeable regarding community resources * Ability to communicate effective to physician and other medical providers * Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Competencies: * Demonstrates commitment to the Fallon Health Mission, Values, and Vision * Specific competencies essential to this position: * Problem Solving: * Asks good questions * Critical thinking skills, looks beyond the obvious * Adaptability * Handles day to day work challenges confidently * Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change * Demonstrates flexibility * Written Communication * Is able to write clearly and succinctly in a variety of communication settings and style Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $58,000 - $64,000 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. #P01

Join a Mission-Driven Team at Fallon Health Summit ElderCare! Locations: Worcester, Leominster, Lowell, Springfield, Webster, Dartmouth - come take a tour and meet the team! Primary Care Physician - PACE Program Salary Range: $275,000-$300,000/year, based on skills and experience. At Fallon Health, we don't just offer jobs-we offer purpose. As part of our Summit ElderCare PACE program, you'll be at the forefront of a growing, innovative model of care that helps older adults live safely and independently at home. If you're passionate about quality over quantity, enjoy working in a collaborative interdisciplinary team, and want to make a real difference in the lives of frail elders, this is the opportunity for you. Work-Life Balance: Monday-Friday, 8-hour days with a flexible schedule, and an optional administrative day with no direct patient care. Patient-centered Care: See an average of 4 patients per day, with an average panel of 65, allowing time for more meaningful care. Team-based Culture: Work alongside a dedicated interdisciplinary team of geriatric care professionals Mentorship & Growth: Benefit from strong peer mentorship and leadership support Mission-driven Work: Help frail elders avoid nursing home placement and live with dignity in the community "PACE is the future of elder care-and Fallon Health is leading the way. If you're looking for a career where your time, expertise, and compassion truly matter, Summit ElderCare is the place to be." About us: 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. Overview: 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/PA), Nurses, Social Workers, Physical and Occupational Therapists, Dieticians, Health Aides, R Brief summary of purpose: The primary role is to provide high quality, cost effective medical care to program participants in accordance with the program mission and participant goals. Responsibilities Primary Job Responsibilities (include duties that represent 5% or more of employee's time) Support the intake and enrollment process by meeting with participants and caregivers to represent the program and conduct initial assessments. Conduct biannual participant assessments. Assist with the development and maintenance of participant care plans. Participate in the interdisciplinary team (IDT) process. Provide routine, preventive and urgent care to participants. Promote strong colloborative relationships between participants, their caregivers and other PACE staff. Provide and arrange for specialty care consultations in support of participant care plans. Incorporate and coordinate specialist reports and recommendations into the medical record, assessments and care planning. Complete all required documentation in the participant chart and other forms as directed. Participate in after hours on call arrangements as determined by the PACE Medical Director. Provide care and assessments of participants in the most appropriate setting including the PACE clinic, inpatient facilites or participants' homes. Participate in committees and work teams as requested by the Medical Director. Work in partnership with the PACE transitional care coordinator to support achievement of quality and utilization goals. Develop effective collaborative relationships with community physicians and other providers. Perform participant chart audits as requested by the PACE Medical Director. Document complete diagnostic and procedure codes in the participant chart and encounter forms to support care plans and accurate revenue collection. Conduct community presentations or represent Summit ElderCare at external functions or meetings upon request of the Medical Director or Executive Director. Pursue professional growth through continuing education that, at the minimum, meets the Massachusetts Board of Registration requirements for license renewal. Assist with education of PACE staff upon request. Perform other duties as needed. Qualifications Education: Medical degree, Geriatric specialty strongly desired License/Certifications: A Doctor of Medicine or osteopathy legally authorized to practice medicine or surgery in the Commonwealth of Massachusetts. Current DEA certificate. Board certification Internal Medicine, Geriatrics or Family Practice preferred. Driving your personal motor vehicle is an essential job function of this position and the following requirements apply: Must possess a valid drivers' license Must attest to no disqualifiers per Driver Safety Policy Must possess and provide proof of minimal state required auto insurance Must have reliable transportation Experience: At least 1 year working with a frail or elderly population. Strong clinical assessment and communication skills Ability to function effectively with an interdisciplinary team (IDT) approach. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $275,000 to $300,000 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. #P01

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: As a valued member of our team, you will be responsible for managing the life cycle of large cross-functional projects that are of highest strategic priorities for Fallon Health. You will bring your project management talents to build relationships with key project stakeholders and external vendors and customers, manage all phases of the projects, and deliver measurable results. Collaborating with a broad group of stakeholders, Project Manager III will ensure appropriate business objectives are defined and will apply their experience and industry-standard practices to manage project activities, communicating effectively with project sponsors, business, and technology partners. Key deliverables include successful execution and project delivery quality that is constrained by project scope, cost and time, delivery on project success criteria, ensure high quality project documentation and reporting, as well as proactive risk mitigation and conflict resolution, while fostering relationships to promote cross-collaboration and positive culture. Responsibilities Primary Job Responsibilities: Leads the planning, execution and monitoring of assigned projects adhering to project management methodologies, ePMO established project management lifecycle, standards and best practices Drives the execution of one or more strategic project(s) of various complexity and significant cross-functional impact with multiple stakeholders Defines and documents project scope, objectives, deliverables and success criteria in collaboration with varies stakeholders across the enterprise Facilitates project kick-off, establish project governance, project team workshops and meetings Develops project plans, timelines and project resource schedules Manages project budget, vendor Statement of Work (SOW), purchase orders (PO) and invoices related to project costs Identifies, communicates and manages project risks, issues and dependencies and develops mitigation strategies and plans Communicates project status and key milestones to stakeholders, providing timely and regular updates through reporting and presentations Interact closely with multiple internal and external parties, including vendors Conducts post project lessons learned, documents areas of improvements and applies to future projects Supports the ePMO with departmental initiatives and projects, share best practices and project management skills to optimize ePMO capabilities Provides coaching, support and guidance to other project managers and project team members Other projects and duties as assigned Qualifications Education: Bachelor's Degree required. License/Certifications PMP Certification preferred Experience: 5 to 8 years of Project Management experience. Health plan experience is a plus PMP Certification is a plus Demonstrated experience of successfully leading complex cross functional business and technology implementations Advanced knowledge with PMP tools, techniques and project development methodologies and Project Life Cycle Ability to comprehend and communicate complex information written and verbal in varied formats to internal and external customers Ability to lead and direct multiple teams for large projects or groups across functional areas, assign accountability, while promoting and fostering teamwork, collaboration and a positive work environment Demonstrate strong leadership and interpersonal skills Ability to develop and deliver effective presentations Outstanding communication, organization and influencing skills Ability to navigate complex projects and respond quickly to changing issues and priorities involving multiple departments and stakeholders Advanced skills with Microsoft applications, such as Project Management tools, Word, Excel, PowerPoint, Visio and other web-based applications. May produce complex documents and produce analysis Project Management Body of Knowledge (PMBOK) Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $125,000 - $135,000 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. Not Ready to Apply? Join our Talent Community now!

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: Under the direction of the SE Site Director, the Dietitian is responsible for the provision and coordination of nutritional care of patients. Evaluates and interprets current nutrition research and disseminates this information to patients, support staff and healthcare providers. Develops and conducts nutrition education programs for patients, staff, community organizations and the local business community. Responsibilities Performs nutrition assessments, evaluation and education for patient base Demonstrates proficiency in age/condition specific appropriate nutrition history taking including presenting condition, past medical/nutritional history. Performs assessment of client's readiness for change and adjusts education goals as appropriate. Requests lab studies when indicated. Discriminates between normal and abnormal lab findings in order to develop nutrition education plan. Establishes plan of nutrition care related to patient's identified problem, including medication, nutrition history, education level and socioeconomic status, etc. Consults with other health care team members regarding nutrition care plan as necessary. Implements plan in safe and effective manner. Documents visit in concise, clear, logical manner. Evaluates need and/or time for follow-up. Recommends appropriate referrals when necessary. Evaluates effectiveness of previously implemented nutrition education/treatment. Develops and provides educational materials and/or programs to patients, families, healthcare professionals. Interprets current nutrition research for patients and healthcare staff. Accepts responsibility for minimizing risk management. Educates patients and staff regarding drug-nutrient interaction. Alerts appropriate medical staff of need for immediate intervention of high-risk patients. Initiates and coordinates team meeting for high-risk patients. Enhances professional growth and self-development through participation in professional activities, educational programs, current literature review, in-service program, and workshops. Participates in defining nutrition standards, practices and educational needs of staff who care for the patient population. Participates in nutrition research. Serves on appropriate healthcare system committees. Provides cross-coverage for other SE sites as needed to cover absences, etc. Develops and conducts continuing education programs for healthcare providers. Complies with health and safety requirements and with regulatory agencies such as DPH, etc. Complies with established departmental policies, procedures, and objectives. Enhances professional growth and development through educational programs, seminars, etc. Attends a variety of meetings, conferences, and seminars as required or directed. Performs other similar and related duties as required or directed. Qualifications Education: Masters degree in nutrition specialty from an accredited college/university preferred. Licenses/Certifications: Active R.D. status with the American Dietetic Association and Valid Driver's License and Clean Driving Record Required Experience: 1-3 years nutrition experience in a health care facility or company/ Proven experience developing and conducting group nutrition programs 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. #P01