Fallon Health PACE Business Operations Manager in Worcester, Massachusetts
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 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 .
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.
Brief summary of purpose:
Serves as the PACE program liaison for departments across the organization providing direct and indirect program support including, Network Development and Management (contracting and provider relations), Accounting, Medical Economics, Claims, Compliance, Enrollment & Billing Operations, Communications, IT, Marketing, and other related ancillary departments in Fallon Health. The Manager, PACE Business Operations produces reports both routine and ad hoc to support PACE leadership in overall program operations and continuous improvement. In the absence of the Senior Director, PACE Operations, acts as primary business operations resource to all Summit ElderCare sites and FHW PACE.
The Manager, PACE Business Operations supports critical program-level strategically important initiatives such as those related to PACE program expansion and CMS audit preparations, and assists the Summit ElderCare Leadership Team in overseeing and managing Summit ElderCare & FHW PACE operational and regulatory functions. This role supports the Summit ElderCare Leadership Team and participates on the Summit ElderCare Quality and Utilization Management Team and other program and organizational committees and workgroups such as Government Programs Vendor Oversight Committee (GPVO), Privacy & Security Committee, Service Advisory Committee, and others as needed and assigned to represent Fallon Health PACE
Regulatory oversight and compliance
In collaboration with FH Compliance department, monitors federal and state regulations pertinent to the PACE program, communicates them to the appropriate Fallon Health teams and leads the implementation of process/program changes as needed.
Manages the implementation of regulatory changes as assigned including communication, education/training and oversight.
Responsible for updating all PACE policies and Process Documents on an annual basis, uploading to the SharePoint site and providing training as needed for new procedures and work flows
Responsible for organizing and preparing the organization for all site reviews or audits conducted by CMS, the State or other regulatory entities
Prepares and manages regulatory submissions and associated follow up related to applications, waivers and other information requests.
Develops policies/procedures and workflows for key operations and manages the communication/implementation.
Participates in assigned workgroups, list serves and committees to monitor regulatory and industry trends
Provides periodic updates to the PACE leadership team
Project management and special projects
Works closely with Fallon Health’s NDM department regarding network contracting initiatives ensuring that the network is sufficient to meet the needs of PACE participants with regard to specialty and facility services.
Serve as lead on key PACE projects as identified.
Works with Fallon Health IT on projects including EMR upgrades and other activities and events that require PACE business testing and analysis
Independently manages assigned projects from design, project plan implementation, education, reporting, post project monitoring/auditing and transition to standard operational processes.
In collaboration with the Senior Director, Clinical Operations and the VP of SE & FHW, completes applications/waivers for PACE program transitions and expansion including State and CMS notifications, contingency planning and working with FH Purchasing department to write RFPs for needed services, etc. transition to standard operational processes.
Data management, analysis, and reporting
Oversees state and regulatory reporting deliverables for PACE
Works in collaboration with the SE Senior Director of PACE Operations on National PACE initiatives.
Assists Senior Director, PACE Operations and VP of SE & FHW with the PACE annual budget process and ongoing financial improvement activities. Participates in quarterly financial reviews with finance department and PACE sites
Updates PACE site staffing grids in collaboration with HR
Conducts analysis of identified business issues as they arise; evaluates and makes recommendations.
Works with Market Research and external third party vendor to ensure Participant and Caregiver satisfaction surveys are administered according to the established timeframes each year. Analyzes satisfaction data for trends and disseminates reports to all PACE leadership for review
Training, marketing and research development
Provides mentoring, training, and leadership to PACE staff as assigned.
Acts as SME as it relates to Fallon Health organizational processes and ensures PACE sites comply with established organizational policies
Conducts independent research including primary and secondary research. Analyzes options and makes recommendations to PACE leadership
Supports marketing plans for PACE to grow membership and reinforce brand awareness in service areas.
Refines product training modules and educational opportunities.
Bachelor’s degree in health care administration, business administration or related field; Master’s degree preferred
A minimum of 3 years of experience in health care, elder services, business administration or related field. Knowledge of regulatory requirements for health insurance industry (Medicare and Medicaid knowledge a plus), excellent written and oral communication skills, excellent organizational and analytical skills, ability to work independently and practice independent judgement, strong problem-solving skills and conflict resolution skills. Knowledge of PACE regulatory requirements a plus
Posted Date 5 days ago (9/22/2021 2:04 PM)
Job ID 6464
# Positions 1
Category Medical Management