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Fallon Health VP/Med Director – Lead Care for Older Adults - Growing PACE Program! in Worcester, Massachusetts

Overview

About us:

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region.

The Opportunity!

Fallon Health has over 25 years of expertise caring for older adults with complex and chronic conditions. Through our PACE (Program of All-inclusive Care for the Elderly) program called Summit ElderCare, we provide care and services to over 1300 participants and we are growing and expanding to have greater reach to those who deserve this program. Summit ElderCare is nationally recognized, one of the largest PACE programs in the country, and is the largest PACE program in New England. Summit is not only central to our mission at Fallon Health of supporting the older adult population but also to Fallon’s strategic plan to drive growth in our government programs.

That’s where you come in… as Summit ElderCare continues to lead the way in forward-thinking models of care for older adults we are looking for that same type of innovation in a Physician Executive who has experience with, and a passion for caring for this population! Read on to learn more or reach out live for more details. We currently have 5 PACE centers in Massachusetts and will be opening an additional center in late 2024.

Responsibilities

Reporting directly to Fallon Health’s Senior Vice President of PACE Programs, the primary role of the PACE Medical Director is to ensure that high quality, cost effective care is provided to PACE program participants in accordance with the PACE program mission, current standards of medical practice, applicable regulatory requirements and Fallon’s requirements.

Responsibilities include:

  • Recruitment, training, supervision and evaluation of employed physicians, advanced practitioners (nurse practitioners and physician assistants). And other clinicians as required.

  • Responsible for ensuring the delivery of participant care.

  • Training and oversight of contracted primary care physicians and advanced practitioners as well as contracted specialists providing session time or other prearranged services.

  • Oversees the development and implementation of the Quality Assessment and Performance Improvement Program (QAPI) in collaboration with the PACE Executive Director and other PACE staff to facilitate achievement of optimal clinical outcomes.

  • Works cooperatively with the Quality and Risk Manager to monitor trends, address identified issues, conduct regular meetings of the quality and Utilization Committee (QUM) and other applicable committees and to operate in accordance with the Board approved annual quality work plan.

  • Monitors utilization management trends and develops interventions to support optimum health of participants, efficient use of program resources and achievement of program goals. Monitors industry benchmarks and participates in the development of utilization targets.

  • Identifies and implements innovative care delivery strategies focused on high quality care, cost containment and achievement of favorable health outcomes.

  • Responsible for the overall development and maintenance of clinical practice policies and procedures.

  • Supports the intake and enrollment processes to meet program goals.

  • Ensures the completion of periodic chart audits for the purpose of monitoring in the areas of quality of care, compliance with PACE regulations, SE policies and utilization plans, appropriate use of medications and identifying areas of risk.    

  • Ensures adequate primary care provider resources are available to meet participant needs and regulatory requirements.

  • Oversees provider after hours on call arrangements to ensure 24 hour provider availability with consideration of provider satisfaction and program budget.

  • Ensures primary care staff and functions support service quality expectations.

  • Organizes systems and educates primary care staff to meet documentation requirements and capture of risk adjustment and encounter data to support accurate revenue capture.

  • Provides consultation and support for program staff regarding grievances, appeals and IDT decision making processes.

  • Stays abreast of current literature and best practices and makes recommendations to adjust policies and procedures as appropriate.

  • Monitors quality of care provided by key contracted providers such as hospitals, SNFs and long term care facilities.

  • Represents Summit ElderCare in the community.

  • Develops collaborative relationships with community physicians and other providers to promote positive, effective working relationships and prospect referrals.

  • Participates as a member of the Summit ElderCare leadership team to develop, implement and promote program mission, vision, strategic plans and achievement of business goals.

  • Promotes collaboration, accountability and continuing professional development of PACE primary care staff via regular group meetings, one on one sessions and other strategies.

  • Participates on committees and workgroups as needed or appoints alternative primary care representatives.

  • Ensures ongoing licensure and competencies of primary care providers and Transitions of Care Coordinators.

  • Represents Summit ElderCare internal to FH on committees and to the FH Board of Directors as required.

  • Represents Summit ElderCare and FH externally with state and federal regulators and the National Pace Association and other committees as necessary.

Qualifications

  • Medical Degree, Geriatric fellowship strongly desired.      

  • A doctor of medicine or osteopathy licensed to practice medicine and surgery in the Commonwealth of Massachusetts with a current DEA certificate.

  • Board certification in Internal Medicine Geriatrics or Family Practice preferred.

  • Extensive experience and expertise practicing medicine with the frail and elder population in a setting leveraging an interdisciplinary approach to care management.

  • Recognized as an exceptional communicator and leader of teams and programs including leading organizations through rapid growth and expansion.

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.

#AP23

Location US-MA-Worcester

Posted Date 1 week ago (5/25/2023 10:45 AM)

Job ID 7315

# Positions 1

Category Physician

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