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Fallon Health Intake & Admissions Coordinator in Amherst, NY, New York


About Fallon Health Weinberg - PACE:

Fallon Health Weinberg-PACE is a long-term care program for older adults who need a nursing-home level of care , but wish to stay living at home and in their community. We are a Program of All-inclusive Care for the Elderly (PACE), providing complete medical care and support services so you or your loved one can remain living safely at home .

All care is coordinated and provided by an interdisciplinary team specializing in geriatric care, who work with participants and their caregivers to create an individualized care plan .

Brief summary of purpose:

Employee follows up on all plan referrals for enrollment into the MLTC. This includes telephone referrals and referrals from outreach staff. These referrals will then begin the process to determine current Medicaid status and movement of the enrollee into the enrollment cycle, which includes working with enrollment staff to schedule assessments and to monitor progress through enrollment to actual start of plan coverage. This position will work closely with outreach coordinators, enrollment nurses and care managers of the MLTC.Goals for this employee include total number of new enrollees for each month and annually.


Responsible for the coordination of the intake and enrollment process to include educating enrollees on:

  • Capitation

  • Enrollment criteria

  • Managed Care

  • Philosophy of the Partially capitated Managed Long Term Care plan

  • Screen intake calls and referrals for appropriateness and communication with members of the team to assist with program enrollment

  • Coordinate evaluations for potential enrollees in order to promote the best potential for a positive experience.

  • Work closely with the Program Director/designee to coordinate and facilitate the Intake & Enrollment process.

  • Provide written and verbal information regarding all potential when enrolled and for enrollees who are not enrolled

  • When possible and/or appropriate, provide and obtain necessary information to families to ensure helpful facilitation of the intake process:

  • Financial statement

  • Medical release

  • Medicaid applicationCoordinate with necessary agencies or facilities to insure appropriate communication and obtain pertinent information.

  • To maintain vital communication and documentation:

  • Coordinate and communicate necessary information with the Program Director/designee on an ongoing basis regarding potential enrollments, to include updating MLTC dashboard and maintaining statistics on conversions.

  • Direct liaison with the DSS to coordinate and provide necessary information regarding potential enrollees

  • Communication and utilization with Maximus/state enrollment broker

  • Coordinate with necessary agencies and/or facilities to ensure appropriate communication with and obtain pertinent information when applicable.

May perform other duties as assigned by Marketing Director

Generally establishes own work plan and priorities, using and/or modifying established procedures, to assure timely completion of assigned work in conformance with established departmental policies and standards


Education: High School Diploma

License/Certifications : N/A


2-3 years customer service experience

Experience handling confidential data that includes HIPAA information

Experience within an insurance company a plus

Familiarity with NY Medicaid a plus

Experience working with Managed Care plans a plus

Resources used in performing role : Microsoft products to include outlook, word and excel; CaseNET TruCare System (proprietary software); QNXT; Business Objects

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.

Location US-NY-Amherst, NY

Posted Date 4 weeks ago (12/30/2020 2:31 PM)

Job ID 6178

# Positions 1

Category Administrative/Clerical