The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

Responsible for working with pre enrollees, participants, caregivers, staff and external regulatory staff (such as Mass Health) and NaviCare NHC pre enrollees to assure that enrollment in the Medicare and Medicaid systems is accomplished accurately and efficiently with appropriate information entered in the FCHP systems. Also, responsible to ensure recertifications are su

The Medical Accounting Senior Accountant (MASA) is a strategic partner to management across the organization. The role requires proficiency in the development, accumulation, and evaluation of key elements necessary to properly report the financial position of the organization. The MASA is responsible to maintain the general ledger's accuracy by creating, processing and/or

Works closely with SE Site Director to provide day to day oversight of PACE operations for assigned PACE site of 400 or more participants. Responsible for coordination and supervision of all clinical staff, financial, and business aspects of a PACE team of 200 participants or more. Manages all administrative functions related to running a PACE center. Responsible for hiri

The Care Coordinator or Navigator partners with Fallon Health Care Team staff and other providers to communicate at all times what is occurring with the member and their status. The Care Coordinator or Navigator seeks to establish telephonic and face to face (depending upon product and circumstance) relationships with the member/caregiver(s) and provider partners to bette

Principal responsibility of the Operations Support Service Analyst IV (Senior Business Analyst) is to collaborate with business areas to design, develop, modify and test reports to support business needs and transaction management. The analyst will leverage their developer skill set and experience with large health care data sets and relational databases to develop comple

Social Worker II Location US MA Webster Job ID 7560 # Positions 1 Category Social Work 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, we deliver equitable, high quality coordinated care and are continually rated among the nation's to

Respond to physician, hospital, ancillary provider inquiries and requests for services associated with the resolution of provider complaints relating to operational concerns, policy and procedures for Fallon Health products and subsidiaries. Understand Fallon Health policies and facilitate and the research required to resolve provider issues. Work collaboratively with int

Physical Therapist Location US MA Dartmouth Job ID 7551 # Positions 1 Category Physical Therapy Overview COMING SOON Fallon Health Opens New Summit Eldercare Site in Dartmouth!! 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 equita

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 di

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 di

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 di

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice. Responsibilities Responsibilities Reviews and implements Provider's orders . Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and M

Functions as a member of the PACE Interdisciplinary Team and provides social work services and support to participants, families and other caregivers. Provides direction to bachelors level social workers as assigned by Social Work Manager. Responsibilities Primary job responsibilities Participates in the intake and evaluation process by conducting the initial social work

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice. Responsibilities Responsibilities Reviews and implements Provider's orders . Conducts nursing assessments according to policy guidelines including physical, psychosocial, behavioral, and M