Fallon Health jobs - 94 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: Under the direction of the Market Research Manager, supports Fallon by making Welcome/Outreach calls to members and/or survey calls to members or providers. Handles confidential patient/member information. Uses strong verbal communication skills and demonstrates excellent telephone communication skills. Understands the importance of leaving a positive impression on any member with whom they come into contact. When necessary, assists member through the creation of formal research cases. Responsibilities Job Responsibilities: Exhibits courtesy, compassion, empathy, and respect in all outbound communications with members and providers. Utilizes proper judgment in handling difficult or unusual calls. Responsible for learning and keeping current with Fallon products, policies and procedures. Responsible for documenting the results of all outbound calls using an electronic or written form. Makes Welcome/Outreach telephone calls to Fallon members providing product knowledge, customer assistance, and problem solving. Administers member telephone surveys. Working from a script, asks both open-ended and closed ended questions of members in order to capture information such as why the member joined Fallon, how satisfied the member is with Fallon and why the member left Fallon. Maintains the highest degree of member/patient confidentiality. Works both as a team member and as an individual depending on assigned project. Works on special projects and other tasks such as focus group recruitment and data entry as assigned by the Market Research Managers or executive staff. Assists Fallon members by creating formal research cases. When necessary, is responsible for properly documenting member issues and entering information into a specialized company database. Competencies: Adaptability - Handles day-to-day work challenges confidently. Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change. Shows resilience in the face of constraints, frustrations or adversity. Demonstrates flexibility Perseverance - Pursues everything with energy and drive and a need to finish. Seldom gives up before finishing, especially in the face of resistance or setbacks. Problem solving - Solves difficult problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Is excellent at honest analysis. Looks beyond the obvious. Independent Action: Duties are generally procedural, allowing the individual to perform independently with intermittent supervision, in conformance with written instructions, established timeframes, and predetermined priorities. Problems not clearly defined by written directions or instructions are reviewed with Market Research Manager to determine course of action. Qualifications Education: • High school diploma or GED is preferred but we would consider relevant customer service call center work experience in lieu of this. • Bachelor's degree or advanced education is also preferred but not required. License/Certifications: N/A Experience: Minimum of one year Customer Service experience in a call center environment Computer skills A brief web-based typing test will be sent out to applicants, and the passing score is 25 net words per minute Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay rate for this position is $19.50 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. 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

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.

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 **Senior Pharmacy Technician** at Village Fertility Pharmacy, 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 - Collaborate 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 details. + **Be a team player** - Escalate complex claims to the appropriate team for further action. + Accurately perform data entry tasks and enter prescriptions into our system. Use the knowledge you gain from training, your problem-solving skills and support from your team to accurately process prescription claims so they will be dispensed accurately. + Juggle multiple tasks without sacrificing attention to detail. + Participate in special projects and perform other duties as it pertains to specific contract performance **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:** + High School Diploma, or GED required. + 1+ years of relevant experience as a technician + Valid National Pharmacy Technician certification is required. + Valid Arizona or Massachusetts pharmacy technician license is required. + 1+ year(s) of call center experience preferred + Microsoft Office proficiency and data entry skills. + Exceptional attention to detail, accuracy, and quality. + Excellent verbal and written communication skills. + Ability to multitask in both PC/Phone related tasks. + Works effectively and fosters teamwork; Demonstrates ownership of projects and carries responsibility for building strong working relationships with colleagues and customers. + Results oriented; demonstrated ability to prioritize and manage workload and meet deadlines. **Training Schedule:** 9a - 5p, EST for 6 weeks. **Post Training Schedule:** 10:30a - 7p, EST, Mon - Fri with 2 Saturdays per month from 9a EST - 4p EST. 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 20 - 30 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. At The Cigna Group, 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), 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, click here (********************************************** . **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 $28 - 30/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

This is one of the better opportunities out there for Health Aides or CNAs and we will take great care of you! Why?.. + *$20/hr to start and exceeds state pay average! You can also make extra depending of the shifts you can work. + Mileage Reimbursement! + Respectful and Desirable Health Aide / CNA Work Setting! Predictable Hours! Safe and highly vaccinated work environment including the member population you care for Our Health Aides and staff love the familiarity and relationships establishes with our members You will likely find more autonomy and flexibility than you have in your current role Our model is low-volume and very member and quality care focused 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. Summary: Provides personal care, light housekeeping and assistance with ADLs (Activities of Daily Living) as outlined in each SE participant's plan of care in participant homes as well as at the PACE center; exercises independent judgement; reports any changes in participant status to the IDT; participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines Responsibilities Under the supervision of the RN, assists with the Activities of Daily Living (ADL) needs of participants both at the PACE center and in participants' homes (i.e., community, Assisted Living Facilities, Rest Homes, Supportive Housing programs, etc.) Contributes to the development of a care plan for participants through interaction with other members of the Interdisciplinary Team. Collaborates with members of the Interdisciplinary Team to assure appropriateness and continuity of care. Carries out non-skilled treatments including, but not limited to vital signs, transfers, toileting, bathing, dressing at the PACE Center and in the community. Assists the Supervisor, Recreational Activities and other activities staff with individual and group programs by helping to plan individual treatment programs, increasing participants' motivation to participate, assisting participants to participate when needed, and assisting with evaluation of program effectiveness. Assists registered therapists and certified therapy assistants with treatments and participant-specific activities which are ordered for each participant and assigned by the registered therapist including, but not limited to, positioning, transfers, ambulation, and exercises. Maintains a clean and safe working and/or living environment in the PACE center and/or participants' homes. Assists with meal and snack preparation, serving, feeding as needed, and clean-up. Uses safe techniques in all interactions with participants at the PACE Center and in participants' homes. Provides accurate and timely documentation in the EMR and other systems as required by SE policies and procedures and/or as assigned by supervisor. Participates in carrying out schedule of daily cleaning and disinfecting of the PACE center in accordance with CDC guidelines for increased precautions Actively participates in distribution of work for health aides to ensure care needs of participants and site tasks are completed timely and appropriately including but not limited to community-based care and center-based tasks, as assigned Actively participates in regular team meetings for health aides at respective site Participates in carrying out infection control precautions and increased cleaning and disinfecting of the PACE center as assigned and in accordance with current CDC guidelines Performs all duties in accordance with FH and Summit ElderCare policies and procedures. Qualifications Education: Completion of an approved Home Health Aide or Certified Nursing Assistant Training Program is highly desirable, but we will accept equivalent work experience in lieu of certificate. Certification: Certification as a Home Health Aide or Nursing Assistant is desired. Reliable Transportation Required. Experience: One year of experience working with a frail and/or older adult population preferably in a PACE program. If under one year, must complete Summit Eldercare training program for health aides prior to working with participants independently. Must complete a standardized set of Summit Eldercare competencies for Health Aides on an annual basis. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $20.00 to $24.00 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. Not Ready to Apply? Join our Talent Community now!

The Telepharmacists serve multiple hospitals, in multiple states, using technology to maximize the cognitive contributions of clinical pharmacists to quality patient care. The Telepharmacist actively engages with clinicians to enhance the performance of care teams and improve outcomes. The Telepharmacist reviews and approves medication orders, conducts clinical interventions as appropriate, and documents all actions in accordance with the policies and procedures of both PipelineRx and its hospital clients. **Schedule** + Part time, weekends, 3rd shift, plus at least 1 on call shift per week. **Responsibilities** + The Telepharmacist will be responsible for providing telepharmacy services for multiple clients and learn multiple pharmacy information systems (PIS's). The Telepharmacist will obtain multiple state licenses. They will prioritize, assign, and evaluate the work of assigned clients; maintain accurate records and document actions taken; maintain confidentiality of information, including HIPAA; understand and interpret the laws, regulations, and policies governing the pharmacy operation. + Performance Objectives + Telepharmacy + Successfully perform telepharmacy services to assigned clients including remote order entry, order verification, drug verification, and counseling (when required). + Communication + Provide leadership, vision, development, and implementation of telepharmacy goals as relayed by the Regional Manager. + Foster a company culture that emphasizes quality, continuous improvement, and high performance as directed by PipelineRx. + Clinical Excellence + Practice pharmacy in a proactive manner and follow policies and procedures as contracted with client. + Provide drug information to clients by answering all drug related questions and give clinical therapeutic recommendations. Questions can be, but are not limited to, drug indication, drug dosage as it relates to renal/liver function or medical condition, drug interactions, drug-drug compatibilities, or drug infusion. + Specific for inpatient, the pharmacist should have working knowledge of (but not limited to) IV fluids, admixture, TPN, narcotic/cardiac drips, IV antibiotics, and chemotherapy. + Be knowledgeable of special age related medical conditions. Important considerations such as (but not limited to): pediatric, geriatric, pregnant/nursing, renal/hepatic impairment, and HIV patients. + Have a working knowledge of, but not limited to: disease state management, drug-drug interactions, drug-nutrient interaction, drug-disease interaction, drug allergies, appropriate dosing by age, renal, or liver function, recognized therapeutic duplications, and be able to give clinical recommendations for medical conditions or disease states. + Counsel patients, nurses, and medical staff on proper use of medications. + Investigate and take appropriate actions(s) to resolve any medication variances to Director of Quality Services within 48 hours of notification. + Operational Excellence + Learn multiple hospital pharmacy information systems. + Obtain multiple state licensures. (MA,NY,OH,PA,WV) + Maintain accurate records and document actions taken by logging orders and interactions with physicians and nurses, including all recommendations made to the clients' staff in the PLRX system during shift and completed in its entirety by end of shift. + Communicate effectively, both orally and in writing, with fellow medical professionals and patients. + Understand, interpret, explain, and comply with laws, regulations, and policies governing pharmacy operations. + Technical Excellence + Provide preliminary technological troubleshooting during breakdowns. + Work simultaneously with VPNs, various pharmacy information systems (PIS's), as well as automation systems and basic computer programs such as Microsoft Office, Snagit, etc. to provide quality care to the clients. + Training and Development + Participate with ongoing training (e.g., clinical, PIS, or policy updates) as necessary in collaboration with regional trainer. + Maintain access codes, licenses, and reciprocity as required for position. + Productivity + Strive to achieve and maintain company productivity metrics. **Qualifications** + Degree in Pharmacy (B.S Pharmacy or PharmD.) + 2+ years' experience in a hospital inpatient preferred + Valid Pharmacist license issued by the governing State Board of Pharmacy + Multiple state licensures (and willingness to serve clients in multiple states including but not limited to MA, NY, OH, PA, WV) + High speed internet service (through cable or fiber provider - no satellite) + A working knowledge of formulary polices, pharmacy and therapeutics policy and procedures + Effective communications skills, both written and verbal + Demonstrated customer service skills + Working knowledge of client/server applications + Proficiency with office technology tools, to include MS Office 2000 or later (esp. Outlook, Excel, and Word), Google Drive, internet, and email 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 54 - 91 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. At The Cigna Group, 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), 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, click here (********************************************** . **About The Cigna Group** Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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 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: The Behavioral Health Clinician provides Behavioral Health services in support of SE participants' health and well-being, and to promote effective caregiving and self-care skills in participants' caregivers and SE staff. Responsibilities Primary Job Responsibilities: Provides behavioral health support to Summit participants as referred by the IDT. Acts as consultant to the IDT and primary care team in supporting participant behavior change, recommending interventions and collaborating with team members in family meetings, discharge planning meetings and care planning, Reviewing service requests and re-authorizations for community-based specialty mental health services. Participates in IDT meetings Facilitates BH Rounds Provides impromptu “curbside” consultation with team members. Attends acute-care or rehab discharge planning meetings as needed. Attends care planning meetings as needed and makes BH recommendations for inclusion in the PACE care plan. Develops and implements psychosocial interventions appropriate to primary care settings. Receives and reviews updates from community-based psychotherapists for medical necessity. Makes recommendations to the IDT regarding appropriateness of initial referrals to psychotherapy and on progress of ongoing psychotherapy. Facilitates case referrals for team consultation to Summit psychiatry consult program. Provides education and training. Conducts trainings on BH topics and skills related to PACE population in general and site-specific population for SE personnel within the paradigm of Summit Eldercare BH program. Provides education to IDT members and other staff related to specific participants' BH needs and general BH principles. Evaluates and provides support to caregivers to improve care giving. Meets with family caregivers as needed to support participant care. Participates in family meetings when requested or otherwise appropriate. Qualifications Education: Masters Degree in Counseling Psychology, Clinical Psychology, Applied Psychology, Rehab Psychology, Mental Health, or Social Work; or Doctorate in Counseling or Clinical Psychology License/Certifications: Massachusetts Licensure for Independent Practice: LMHC, LMFT, LICSW, Licensed Psychologist Experience: Experience in providing behavioral health services in outpatient primary care medical offices or similar healthcare settings is helpful. At least one year of experience working with older adults. Experience with Cognitive-Behavioral, Motivational Interviewing, Solution-Focused, Transtheoretical, and Interpersonal Theory techniques for promoting behavioral change. Understanding of physiological, psychological and neuropsychological contributors to behavior in diverse clinical populations. Ability to use clinical judgment to provide appropriate and effective treatment Ability to diplomatically maintain client confidentiality and HIPPA standards when including family members and caregivers in discussions or consultations. Able to work as a team member. Access to reliable transportation to carry out community assignments is required. Excellent written and verbal communication skills. Excellent organization and time management skills and ability to complete record-keeping in a timely manner required. Facile with computer applications including an Electronic Medical Record. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay for this position is$ 88,000 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. 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!

**Details** _Kemper is one of the nation's leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper's products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises. _ **Position Summary:** Manages and supervises actuarial analysts by assigning work, providing technical guidance and other responsibilities to include performance management, training and mentoring. Performs highly complex pricing analyses. Prepares and analyzes complex internal management information. This position works closely with the Actuarial Director, Product Managers, Data Scientists, business partners, and senior leaders to develop appropriate pricing and product strategies to support organizational goals. Assists with department objectives by leading and coordinating projects and processes and maintaining actuarial standards of practice. **Position Responsibilities** : + Robust understanding of actuarial pricing methodology + Oversee the production of sound premiums and policy values + Support state filing process with actuarial certification (regulatory sign-off), actuarial memorandum and support, and correspondence with regulators, and documentation of assumptions and/or analysis + Ability to perform complex pricing analyses, such as premium calculations, policy value calculations, sensitivity testing, compliance testing and ad-hoc analysis + Assist with and enforce best practices in quantifying, validating, and preparing proposed premiums + Prepare actuarial proposals for management and business partners + Pull, aggregate, and query experience data + Develop recommendation on premiums and policy values to satisfy financial objectives of the organization + Perform complex experience analysis (e.g. mortality and lapse analysis) + Automate and enhance processes to improve efficiencies + Support and/or lead the development and design of new plans, programs, processes, products up to moderate complexity + Oversee financial forecasting/planning process + Complete pricing projects and ad-hoc requests + Develop management information to inform business partners on the health of the business + Communicate effectively with management and business partners + Adhere to internal and external compliance requirements/standards + Assist with the development of junior-level staff + Develop skills through continuing education opportunities + Meet expectations for Society of Actuaries (SOA) exam progress and/or continuing education **Position Qualifications** : + 5-7 years of experience as an actuarial analyst, including Life Insurance experience + Associate (ASA) or Fellow (FSA) of the Society of Actuaries or the equivalent from other organizations or demonstrates equivalent knowledge + Bachelor's degree in actuarial science, mathematics, statistics, economics or related field, or the equivalent in related work experience + Competitive candidates will have: + Experience managing actuarial analysts + Proficiency in VBA + Proficiency in SQL, SAS, Python or R + Proficiency in actuarial modeling software (e.g. GGY-AXIS, MG-ALFA, PolySystems, etc.). GGY-AXIS actuarial modeling is strongly preferred. + Strong analytical skills + Strong understanding of actuarial ratemaking methodologies and practices + Advanced understanding of financial reporting (e.g. GAAP, Stat, income statement, balance sheet, etc.) + Perform actuarial pricing analysis independently and makes reasonable assumptions/judgments + Understand and make observations on market implications of business strategies + Creative problem-solver with strong quantitative skills that can spot patterns, trends, and opportunities in data + Propose and implement improvements in actuarial methodologies and analyses + Strong written and verbal communication skills to convey complex topics in an understandable, concise manner to both technical and non-technical audiences + Organizational skills including time management and the ability to handle multiple priorities + Track own plan performance and project timelines + Work effectively to meet deadlines + Proven contributor of ideas for enhancements in procedures and processes to improve efficiencies + Take initiative to lead projects of both a technical and non-technical nature + Ability to review others' work for reasonableness and identify opportunities for enhancement + Develop actuarial staff + Interpersonal skills + Works effectively in a team environment + Sponsorship is not accepted for this opportunity + This is a remote role and can be worked from any US-based home The range for this position is $111,900 to $186,700. When determining candidate offers, we consider experience, skills, education, certifications, and geographic location among other factors. This job is eligible for an annual discretionary bonus and Kemper benefits (Medical, Dental, Vision, PTO, 401k, etc.) Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination. Kemper is focused on expanding our Diversity, Equity, and Inclusion efforts to align with our vision, mission, and guiding principles. Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee. **_Kemper will never request personal information, such as your social security number or banking information, via text or_** **_email. Additionally,_** **_Kemper does not use external messaging applications like WireApp or Skype to communicate with_** **_candidates. If_** **_you receive such a message, delete it._** \#LI-JO1 \#LI-Remote **Kemper at a Glance** The Kemper family of companies is one of the nation's leading specialized insurers. With approximately $12 billion in assets, Kemper is improving the world of insurance by providing affordable and easy-to-use personalized solutions to individuals, families and businesses through its Kemper Auto and Kemper Life brands. Kemper serves over 4.6 million policies, is represented by approximately 24,200 agents and brokers, and has approximately 7,500 associates dedicated to meeting the ever-changing needs of its customers. *Alliance United Insurance Company is not rated. _We value diversity and strive to be an employer of choice. An Equal Opportunity Employer, M/F/D/V_ **Our employees enjoy great benefits:** - Qualify for your choice of health and dental plans within your first month. - Save for your future with robust 401(k) match, Health Spending Accounts and various retirement plans. - Learn and Grow with our Tuition Assistance Program, paid certifications and continuing education programs. - Contribute to your community through United Way and volunteer programs. - Balance your life with generous paid time off and business casual dress. - Get employee discounts for shopping, dining and travel through Kemper Perks.

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 A verifiable high school diploma or GED is required for all positions at Fallon Health and its affiliates, unless specified otherwise. 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!

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. #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 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!

This position covers Lynn and Saugus plus Chelsea, Essex, Everett, Hamilton, Lynnfield, Malden, Melrose, Nahant, Revere, South Hamilton, Swampscott and Winthrop. 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 Nurse Case Manager (NCM) 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. NCM 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 NCM and Care Team. Responsibilities may include conducting in home 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 NCM may conduct assessments and may determine the number of hours' members require for MassHealth programs such as the personal care attendant program, adult foster care, group adult foster care, and other programs per product benefits and guidelines. The NCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Note: Job Responsibilities may vary depending upon the member's Fallon Health Product 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 medication reconciliations Performs Care Transitions Assessments - per Program and product line processes Utilizing clinical judgment and nursing assessment skills, may complete NaviCare Program Assessment Tools and Minimum Data Set Home Care (MDS HC) Form when a member's medical/functional status changes that warrants a change in rating category to ensure members are in the correct State defined rating category Maintains up to date knowledge of Program and product line 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 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 Educate members on preventative screenings and other health care procedures such as vaccines, screenings according to established protocols and program processes such initiatives involving Key Metrics outreach 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 Navigator to ensure the member approves their care plan Manages NaviCare members in conjunction with the Navigator, Behavioral Health Case Manager, Aging Service Access Point Geriatric Support Service Coordinator, contracted Primary Care Providers and others involved/authorized in the member's care Manages ACO members in conjunction with the 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 Provider Partnerships and Collaboration May attend in person 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 Centralized Enrollee Record according to product regulatory requirements and Program policies and processes Knowledge of and compliance with HEDIS and Medicare 5 Star measure processes, performing member education, outreach, and actions in conjunction with the Navigator and other members of the Clinical Integration and Partner Teams 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: Graduate from an accredited school of nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field preferred. License: Active, unrestricted license as a Registered Nurse in Massachusetts Certification: Certification in Case Management strongly desired Other: Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation Experience: • 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required • Understanding of Hospitalization experiences and the impacts and needs after facility discharge required • Experience working face to face with members and providers preferred • Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking, required • Home Health Care experience preferred • Effective case management and care coordination skills and the ability to assess a member's activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member's need working in partnership with a care team preferred • Familiarity with NCQA case management requirements 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 insurance regulatory and accreditation requirements • Knowledgeable about software systems including but not limited to Microsoft Office Products - Excel, Outlook, and Word • Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables • Accurate and timely data entry • Effective case management and care coordination skills and the ability to assess a member's activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member's need • Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria • 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 styles. Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $95,000 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 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 preferred. 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!

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: Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, CMS 5 Stars, NCQA standards, other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage 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 Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department and Provider Appeals Department. This position will also provide administrative support to the departments. Serves as liaison between Fallon Health members and contracted providers regarding appeals and grievances. Responsibilities Primary Job Responsibilities This position is divided equally between Member Appeals and Grievances Department and Provider Appeals Department with 20 hours dedicated to each department per week - with a total of 40 hours/week. Act as the initial investigator and contact person for 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. Acts as the initial investigator for provider appeals related to filing limit, claim denials, claim payment, retrospective referrals, administrative inpatient days and other issues for which the provider is liable. Responsible for processing all incoming mail, as well as forwarding all initial claim submissions, claim adjustments, and other miscellaneous mail to appropriate departments. Managing incoming faxes, emails, voicemails and member/provider specific data, routing to the appropriate staff member. 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 appeal/grievance management. 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. Processing of reports which produce all correspondence to providers related to appeal determinations and untimely requests, as well as sending those correspondence to providers. Filing of individual provider appeals files in accordance with department standards. Maintain provider appeal database and analyze data to assist provider appeal coordinators in production of monthly reports forwarded to management. Print and mail letters at the FH corporate office located at 1 Mercantile Street, Worcester, MA several times per month or as needed, as designated through a rotational in-office calendar or at the direction of a supervisor or manager. Qualifications Education High School Diploma or GED required. License/Certification Reliable Transportation required Experience Minimum 2 years' experience in the operational side of a healthcare or insurance organization preferred. 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. #P02

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: Under the direction of the Market Research Manager, supports Fallon by making Welcome/Outreach calls to members and/or survey calls to members or providers. Handles confidential patient/member information. Uses strong verbal communication skills and demonstrates excellent telephone communication skills. Understands the importance of leaving a positive impression on any member with whom they come into contact. When necessary, assists member through the creation of formal research cases. Responsibilities Job Responsibilities: * Exhibits courtesy, compassion, empathy, and respect in all outbound communications with members and providers. Utilizes proper judgment in handling difficult or unusual calls. * Responsible for learning and keeping current with Fallon products, policies and procedures. * Responsible for documenting the results of all outbound calls using an electronic or written form. * Makes Welcome/Outreach telephone calls to Fallon members providing product knowledge, customer assistance, and problem solving. * Administers member telephone surveys. Working from a script, asks both open-ended and closed ended questions of members in order to capture information such as why the member joined Fallon, how satisfied the member is with Fallon and why the member left Fallon. * Maintains the highest degree of member/patient confidentiality. * Works both as a team member and as an individual depending on assigned project. * Works on special projects and other tasks such as focus group recruitment and data entry as assigned by the Market Research Managers or executive staff. * Assists Fallon members by creating formal research cases. When necessary, is responsible for properly documenting member issues and entering information into a specialized company database. Competencies: * Adaptability - Handles day-to-day work challenges confidently. Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change. Shows resilience in the face of constraints, frustrations or adversity. Demonstrates flexibility * Perseverance - Pursues everything with energy and drive and a need to finish. Seldom gives up before finishing, especially in the face of resistance or setbacks. * Problem solving - Solves difficult problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Is excellent at honest analysis. Looks beyond the obvious. Independent Action: * Duties are generally procedural, allowing the individual to perform independently with intermittent supervision, in conformance with written instructions, established timeframes, and predetermined priorities. Problems not clearly defined by written directions or instructions are reviewed with Market Research Manager to determine course of action. Qualifications Education: * High school diploma or GED is preferred but we would consider relevant customer service call center work experience in lieu of this. * Bachelor's degree or advanced education is also preferred but not required. License/Certifications: N/A Experience: * Minimum of one year Customer Service experience in a call center environment * Computer skills * A brief web-based typing test will be sent out to applicants, and the passing score is 25 net words per minute Pay Range Disclosure: * In accordance with the Massachusetts Wage Transparency Act, the pay rate for this position is $19.50 per hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. 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

Home Infusion Registered Nurse - Accredo Specialty Pharmacy Join Accredo Specialty Pharmacy, part of Evernorth Health Services, and bring your nursing expertise to patients where they feel most comfortable-their homes. As a Home Infusion Registered Nurse, you'll deliver life-changing care while building meaningful relationships and driving positive health outcomes. Responsibilities: Provide safe and effective administration of specialty medications (including IV infusion) in patients' homes. Partner with pharmacists and care teams to ensure holistic patient well-being. Document assessments, treatments, and progress to maintain accurate patient records. Serve as the primary point of contact for patient updates and care coordination. Demonstrate autonomy in clinical decision-making to achieve optimal outcomes. Required Qualifications: Active RN license in the state of practice. Minimum 2 years of RN experience. At least 1 year in critical care, acute care, or home healthcare. Proficiency in IV insertion and infusion techniques. Valid driver's license and ability to travel within a large geographic region. Availability for a 40-hour work week, flexible schedule. Preferred Qualifications: Bachelor of Science in Nursing (BSN). Experience with specialty pharmacy or infusion therapy programs. Benefits: Medical, Dental, Vision, and Life insurance 401k with strong company match Mileage reimbursement and/or company car 26 Paid Days Off (18 days PTO, plus 8 company holidays) Merit and Bonus eligibility 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 79,200 - 132,000 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. At The Cigna Group, 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), 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, click here. 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.

As a Pharmacy Technician Representative , you will be assisting patients in receiving needed medications to help achieve their dreams of building a family. You'll be empowered to engage patients, insurance companies, and multiple departments to process orders and ensure timely shipment of medications. This role is very detail oriented, and you'll spend most of your day working on our computer system. Training Schedule: 9a - 5:30p EST, Mon - Fri. Work Schedule: 9a -5:30p EST 3 days per week and 12:30p - 9p EST 2 days per week, Mon - Fri. Rotating Saturday's are required. What you'll do: • Support daily workflow in the pharmacy. • Accurately enter prescriptions into our system. • Interact with healthcare providers and provide guidance to patients about medication coverage. • Identify ongoing training and retraining opportunities on team. • Adhere to SOP/SWI. • Cross trained in multiple areas while maintaining proficiency and accuracy. • Juggle multiple tasks without sacrificing attention to detail. What you need to do the job: • High School diploma or equivalent required. • 1+ year(s) relevant experience. • Valid MA Pharmacy technician license required and PTCB preferred, if not certified willing to take PTCB test in 6 months from hiring date. • Basic Math skills and Strong experience with MS Office, especially with Excel. • Excellent communication skills; written and verbal. • Strong attention to detail, accuracy, and quality. • Ability to work collaboratively in a dynamic environment to learn quickly, solve problems, and make decisions with minimal supervision. • Willingness to work a flexible schedule. What you'll love about working at Cigna: Fun, friendly, and unique culture - Bring your whole self to work every day! Medical Dental & Vision start 1st day 18 days Paid Time Off & 8 Paid Holidays Employer Contributions for HRA and HSA accounts 401K with Company Match Tuition Assistance 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 17.88 - 26 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 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: The Behavioral Health Clinician provides Behavioral Health services in support of SE participants' health and well-being, and to promote effective caregiving and self-care skills in participants' caregivers and SE staff. Responsibilities Primary Job Responsibilities: Provides behavioral health support to Summit participants as referred by the IDT. Acts as consultant to the IDT and primary care team in supporting participant behavior change, recommending interventions and collaborating with team members in family meetings, discharge planning meetings and care planning, Reviewing service requests and re-authorizations for community-based specialty mental health services. Participates in IDT meetings Facilitates BH Rounds Provides impromptu "curbside" consultation with team members. Attends acute-care or rehab discharge planning meetings as needed. Attends care planning meetings as needed and makes BH recommendations for inclusion in the PACE care plan. Develops and implements psychosocial interventions appropriate to primary care settings. Receives and reviews updates from community-based psychotherapists for medical necessity. Makes recommendations to the IDT regarding appropriateness of initial referrals to psychotherapy and on progress of ongoing psychotherapy. Facilitates case referrals for team consultation to Summit psychiatry consult program. Provides education and training. Conducts trainings on BH topics and skills related to PACE population in general and site-specific population for SE personnel within the paradigm of Summit Eldercare BH program. Provides education to IDT members and other staff related to specific participants' BH needs and general BH principles.Evaluates and provides support to caregivers to improve care giving. Meets with family caregivers as needed to support participant care. Participates in family meetings when requested or otherwise appropriate. Qualifications Education: Masters Degree in Counseling Psychology, Clinical Psychology, Applied Psychology, Rehab Psychology, Mental Health, or Social Work; or Doctorate in Counseling or Clinical Psychology License/Certifications: Massachusetts Licensure for Independent Practice: LMHC, LMFT, LICSW, Licensed Psychologist Experience: Experience in providing behavioral health services in outpatient primary care medical offices or similar healthcare settings is helpful. At least one year of experience working with older adults. Experience with Cognitive-Behavioral, Motivational Interviewing, Solution-Focused, Transtheoretical, and Interpersonal Theory techniques for promoting behavioral change. Understanding of physiological, psychological and neuropsychological contributors to behavior in diverse clinical populations. Ability to use clinical judgment to provide appropriate and effective treatment Ability to diplomatically maintain client confidentiality and HIPPA standards when including family members and caregivers in discussions or consultations. Able to work as a team member. Access to reliable transportation to carry out community assignments is required. Excellent written and verbal communication skills. Excellent organization and time management skills and ability to complete record-keeping in a timely manner required. Facile with computer applications including an Electronic Medical Record. Pay Range Disclosure:In accordance with the Massachusetts Wage Transparency Act, the pay for this position is$ 88,000 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. 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 * A verifiable high school diploma or GED is required for all positions at Fallon Health and its affiliates, unless specified otherwise. 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.