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Fallon Health Project Manager - Health Insurance Network Development and Management (NDM) -Hybrid 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.

Brief summary of purpose:

Primary responsibilities include identification, evaluation, implementation and prioritization of provider management initiatives and network operations tasks. These include the coordination of provider focused projects. Responsibilities include supporting the NDM Team and management in promoting greater collaboration, synergies and integration across multiple Fallon teams. Ensures adherence to Program plans and schedules and develops solutions to program and project challenges. This position has a significant focus on the skill and diplomacy/tact required in working across functional areas and external organizations to ensure key initiatives are progressing as planned. These projects are multifunction and may be multiyear in scope.

Responsible to provide expert knowledge of development methodology approaches, techniques and tools to senior management, project managers, program teams and project teams.


Primary Job Responsibilities

  • Supports the development, implementation, and measurement of NDM and Fallon initiatives.

  • Supports the development with business owners of opportunity analysis including coordinating with Medical Economics on actuarial evaluation.

  • Attends monthly Operations and Care Services meetings. Facilitates planning sessions for annual initiative development and for prioritized initiatives

  • Prioritizes and supports allocation of available project and/or program resources to ensure goals and objectives of the cost of care initiatives are met and participates in analytical review of savings opportunities.

  • Ability to complete necessary tasks for NDM associated with and required to move projects to timely and successful completion.

  • Provides project management support to NDM management in developing cross-departmental synergies, collaboration, and integration to eliminate inefficiencies and ensure optimal use of resources across the organization.

  • Demonstrates influencing skills in managing team members, stakeholders and senior leadership.

  • Develops and maintains strong partnerships with management at all levels of one or more business units.

  • Provides timely and effective communication of project status and key milestones to all stakeholders.

  • Works with NDM Management Team to develop department dashboards.

  • Supports business owners in developing and tracking outcomes/success metrics and ensures accurate and timely reporting of key metrics.

  • Participates in Payment Policy Committee, Unit Cost Projects, creates Utilization Reports and identifies other cost drivers.

  • Ensures adherence to Program plans and schedules and develops solutions to Program and project challenges.

  • Performs other duties as assigned.



Business Degree required preferably in Business Administration, MBA preferred; contracting background valuable but not required.


PMP or Certified Lean Six Sigma highly desirable


Requires demonstrated skill in leading cross-functional teams. Required 5+ years of project management experience in the field or in a related area. Relies on extensive experience and judgment to plan and accomplish goals. Experience in analyzing and utilizing data to drive business decisions. At least 5 years’ experience in healthcare analysis and/or management. Proficient in Microsoft Windows based office applications to include, MS Project, Excel, Word, PowerPoint, Visio, and SharePoint. Ability to learn Quest software system.


  • Strong verbal and written communication skills

  • Build Relationships - Relates to people in an open, friendly, accepting manner; initiates and develops relationship with others as a key priority; treats others with respect; is approachable.

  • Presentation Skills - Effective in a variety of formal presentation settings: one-on-one, small and large groups, with peers, subordinates, and bosses; speaks effectively.

  • Works Efficiently - Allocates own time efficiently; handles multiple demands and competing priorities; eliminates inefficiencies; conducts effective meetings.

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 2 months ago (10/15/2021 7:27 PM)

Job ID 6560

# Positions 1

Category Network Development