Under the general direction of the Senior Manager, Clinical Quality, the clinical nurse analyst is responsible for developing and implementing the assigned quality improvement initiatives, documentation of the processes, tracking of results and reporting outcomes. Other key responsibilities include medical record data abstraction for Healthcare Effectiveness Data and Info

With general direction from the Director of Quality, the Program Manager, Accreditation & Audit ensures that the health plan is compliant with the National Committee for Quality Assurance standards, the regulations promulgated by the Centers of Medicare and Medicaid, the Massachusetts Division of Medical Assistance, and the Division of Insurance. This position takes the l

Responsible for the development and coordination of all life enrichment activities at each PACE Day center location and the supervision of the Life Enrichment Assistants. This position oversees the development of programming, the management of staff, the oversight of supplies and related budget and pursues new ideas that all result in the provision of meaningful, purposef

Responsible for the coordination and timely completion of provider appeals. Serves as a liaison between Fallon Health and contracted and non contracted providers with appeals regarding filing limit appeals, claim denials, claim payment, retrospective referrals, administrative inpatient days and other issues for which the provider is liable. Responsibilities Primary Job Re

As a Solution Architect, you will be responsible for aligning Fallon's business strategy with technology solutions to drive process improvement, competitive advantage, and innovation. You will engage business and IT stakeholders at all levels of the organization to understand the business strategy, capabilities and processes and use this data to identify and shape solutio

Product Manager IV Growing Healthcare Organization Duals Program experience required. Location US MA Worcester Job ID 7579 # Positions 1 Category Project Management 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, Fallon Health deliver

Under general supervision of the Rehab Manager and Lead Therapist provides and documents the full range of Occupational Therapy assistant treatments and tests to all categories of patients, supervises supportive personnel and participates in educational services. Acts as a clinical instructor and is responsible for teaching inter department continuing education/in service

Responsible for the effective management and delivery of direct nursing care to PACE participants in any setting utilizing nursing process and adhering to standards of nursing practice. Responsibilities Primary Job Responsibilities Primary nurse not only has the responsibility for the participant, but the authority to advocate for the best care for the participant unique

Under the direction of the SE Site Director, the Dietitian is responsible for the provision and coordination of nutritional care of patients. Evaluates and interprets current nutrition research and disseminates this information to patients, support staff and healthcare providers. Develops and conducts nutrition education programs for patients, staff, community organizatio

Manages a primary care panel of participants and provides continuity primary health care to PACE participants that reside in the community or long term care setting with a focus on goal oriented, person centered care, disease progression, disease prevention, wellness and management of chronic and episodic illness consistent with the participant's goals of care. Works in c

Provides personal care, light housekeeping and assistance with ADLs (Activities of Daily Living) as outlined in each SE participant's plan of care in participant homes as well as at the PACE center; exercises independent judgement; reports any changes in participant status to the IDT; participates in carrying out infection control precautions and increased cleaning and di

Join the dynamic team of Enterprise Project Management Office (ePMO)! As a valued member of our team, you will be responsible for managing the life cycle of large cross functional projects that are of highest strategic priorities for Fallon Health. You will bring your project management talents to build relationships with key project stakeholders and external vendors and

The Medical Economics Data/Financial Analyst will partner with Medical Economics team members in assistance of data and reporting automation and package development, to support internal product line owners, as well as external provider partners. This role will be responsible for engaging with other analysts within the Finance Division and business users to ensure data qua

Provides coordination, scheduling and problem resolution for all approved home care services for Summit Eldercare participants. Documents all actions in a timely manner in an electronic medical record (EMR). Supports other program administration needs as assigned. Responsibilities Coordinates and schedules home care services to implement the plan of care established by th

The Revenue Senior Account I is a strategic partner to management across the organization. The role requires proficiency in the development, accumulation, and evaluation of key elements necessary to properly report the financial position of the organization. The role is responsible to maintain the general ledger's accuracy by creating, processing and/or recording business