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Fallon Health LPN - Navigator -Fallon Health Weinberg - Growing MLTC - Niagara/Erie in Amherst, NY, New York


About Fallon Health Weinberg - MLTC:

Fallon Health Weinberg-MLTC is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg a Managed Long-Term Care (MLTC) is a plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high quality, affordable health care.

Brief Summary of Purpose:

The Navigator helps the primary care provider, care manager, community liaisons and other providers know at all times what is occurring with the Member and their status. Responsibilities include: placing referrals and following up to ensure services are in place as per the individual care plan; coordinating and documenting Inter-disciplinary Care Team meetings, facilitating data transfers and ensuring the Centralized Enrollee Record (CER) and Core System is up to date. The Navigator works closely with the Care Manager. The Navigator refers to the Care Manager whenever clinical decision making is required. To effectively advocate for Enrollee needs, the Navigator makes in home visits/long term care facility visits with/without the Care Manager to fully understand an Enrollee/member care needs.

The Navigator seeks to establish a relationship with the Enrollee/member/caregiver(s)/facilities to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.


Job Responsibilities:

  • Outreaches to all new Fallon Health Weinberg Enrollees within designated periods from start date of enrollment via the telephone and/or in person. Introduces self/role and ensures the Enrollee/caregiver/facility is orientated to the Program and benefits

  • Acts as Enrollees advocate

  • Gathers data from the Enrollee’s medical record in areas such as preventative health screenings, working with the Enrollee and Primary Care Provider to ensure the Enrollee receives health care according to established guidelines

  • Responds to Enrollee/caregiver/Facility questions or concerns about health/benefits

  • Makes in home/institutional/office visits as need be to introduce self/role and ensure the Enrollee/caregiver/facility is orientated to the Program and benefits

  • Coordinates Enrollee visits to the Primary Care Physician (PCP) and other clinicians as appropriate based upon clinical need and program guidelines, including but not limited to ensuring adequate transportation

  • Coordinates/schedules IDT meetings on a regular basis depending upon Enrollee needs according to Department guidelines

  • Ensures IDT meeting summaries are entered/scanned into the CER per Department process

  • Coordinates and ensures members of the Care Team (i.e. Director of Clinical Service, Care Manager, and others) are involved and knowledgeable about the Enrollee status based upon Enrollee need and PCP/PCT direction at all times

  • Ensures authorizations for specific covered services are entered into the CER as appropriate based upon Department processes

  • Ensures the Enrollee’s Individual Plan of Care (IPC) is up to date in conjunction with plans developed by members of the Primary Care Team/Primary Care Physician

  • Ensures the Enrollee is in agreement with their IPC and documents Enrollee approval of such in the CER

  • Ensures the Care Manager follows up with Enrollees after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission

  • Works with the emergent/urgent/acute care/skilled nursing facility provider to obtain discharge documentation and ensures information is entered/scanned into the CER per Department process and shared with all members of the team

  • Responsible for updating and maintaining accuracy of panel access data base lists – processes according to Department guidelines

  • Identifies and shares best practices and innovative care management strategies with the team

  • Resolves conflicts among participants in the care planning process

  • Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the Enrollee attains pre-determined outcomes

  • Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/designee

  • Strictly observes HIPPA regulations and the FHW policies regarding confidentiality of member information

  • Performs other responsibilities as assigned by the Supervisor/designee.



  • High School graduation

  • Graduation from an accredited Licensed Practical Nurse Program


  • Current NY Driver’s License

  • Current license to practice as an LPN in the state of NY


  • 1 year job experience in a medical related field or with a healthcare payor company a plus.

  • Experience with telephonic/ person interviewing skills

About Fallon Health:

Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.

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.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Location US-NY-Amherst, NY

Posted Date 4 weeks ago (2/28/2023 11:23 AM)

Job ID 7209

# Positions 1

Category Other