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Fallon Health Assistant Site Director - Growing Healthcare Organization in Worcester, Massachusetts

Overview

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About Summit ElderCare :

Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.

Position Purpose:

Works closely with SE Site Director to provide day to day oversight of PACE operations for assigned PACE site. Manages all administrative functions related to running a PACE center. Responsible for hiring, training, supervision and retention of support/administrative staff, Supervisor of Recreational Activities. Responsible for oversight of all PACE center staff in the absence of the Site Director. Oversees the timely and accurate processing of claims, data collection and reporting including those related to the Electronic Medical Record (EHR). Assures that all functions are completed in an accurate and timely manner. Maintains a positive, professional, collaborative relationship with staff and vendors. Ensures all Level one and two incidents and grievance investigations and reports are filed in a timely manner in accordance with PACE regulations and SE policies and procedures. Acts as PACE site Transportation Coordinator and oversees the provision of transportation services for all site participants. Responsible for all site facilities management, working closely with Director of Facilities to ensure all systems are working properly and all equipment is maintained according to the prescribed schedule. Acts as SE liaison to site vendors. Works closely with Outreach & Enrollment staff to ensure the intake process flows smoothly, to ensure prospects are scheduled in a timely manner and the team is prepared for swift enrollment decisions. Acts as back up to Site Director in his/her absence. Oversees the site Activity program working closely with the Supervisor of Recreational Activities to ensure age-appropriate, interesting and varied activities are available for participants on a daily basis.

Responsibilities

  • Provides oversight of day to day PACE center operations in collaboration with SE Site Director acting as primary back up in his/her absence

  • In collaboration with SE Site Director, analyzes and manages utilization metrics and targets to ensure favorable financial outcomes

  • Manages Incident and Grievance reporting for the PACE site ensuring all reports are filed and completed in the established timeframe

  • Responsible for all Level one and two investigations and reports working closely with assigned Quality RN

  • Manages all supervisory functions for site based support staff and Supervisor of Recreational Activities including hiring, training and performance management. Completes annual employee evaluations and competencies. Conducts monthly staff meetings. Conducts regular touchpoint meetings with all direct reports to provide guidance and feedback on progress toward established goals    

  • Oversees intake and enrollment process for prospective enrollees, working closely with Outreach and Enrollment staff    

  • Assures that all demographic and other non-clinical information is entered into the EHR and documents are scanned according to established procedures.   

  • Acts as Site Transportation Coordinator to assure safe and timely transport of all participants to/from the site, home and appointments. Meets regularly with transportation vendor to work through any issues and foster good rapport 

  • Meets regularly with vendors to ensure open communication and collaboration in service provision for participants   

  • Collects and enters all data related to HPMS reporting for PACE site.  

  • Oversees the timely processing of all claims and invoices and referrals, ensuring all external appointments are scheduled timely.     

  • Receives and processes all memorial donations ensuring letters of appreciation are sent in a timely manner      

  • Maintains attendance logs and meeting minutes and certification logs as requested by Site Director.

  • Assures that front-desk/reception area is staffed at all times while site is open.

  • Manages and maintains appointment scheduling functions including assisting participants with scheduling outside appointments.

  • Responsible for attending and taking minutes for various meetings as assigned by the Site Director.

  • Works with Director of Facilities to ensure all equipment and systems are maintained and in good working order; reports issues immediately

  • Acts as facilitator of SE Office Supervisor committee meeting regularly and providing guidance and leadership to work through issues affecting all sites

  • Other duties and special projects as assigned by the Site Director

Qualifications

Associates degree Required; Bachelor of Science in Nursing or other clinical discipline preferred

At least 3 years supervisory experience in a clinical care setting

Experience in a health care or insurance setting preferred but not required.

PACE experience or experience in an integrated value-based clinical care model preferred

Excellent computer skills including familiarity with information retrieval, data collection and word processing

Excellent verbal and written communication skills

  • Extensive Clinical Knowledge & Understanding

  • Recruiting, Hiring, Coaching and developing others

  • Fosters open communication

  • Utilization Management

  • Concise Decision Making

  • Effective Problem solving

  • Excellent Oral & Written communication

  • Leadership Presence

  • Ability to exercise independent judgment

  • Analytical Thinking

  • Adaptability

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-MA-Worcester

Posted Date 1 month ago (3/2/2020 5:24 PM)

Job ID 5924

# Positions 1

Category Care Coordination

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