The Manager works closely with their counterpart to assist the Senior Director, PACE Operations to manage the program level operational and regulatory functions related to Fallon Health's PACE programs. Responsible for compiling reports and analyzing data and making program level recommendations. T he Manager supports the Senior Director, PACE Operations to manage program

Respond to physician, hospital, ancillary provider inquiries and requests for services associated with the resolution of provider complaints relating to operational concerns, policy and procedures for Fallon Health products and subsidiaries. Understand Fallon Health policies and facilitate and the research required to resolve provider issues. Work collaboratively with int

The Nurse Case Manager (NCM) is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members. NCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the mem

The Medical Accounting Senior Accountant (MASA) 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 MASA is responsible to maintain the general ledger's accuracy by creating, processing and/or

Works closely with SE Site Director to provide day to day oversight of PACE operations for assigned PACE site of 400 or more participants. Responsible for coordination and supervision of all clinical staff, financial, and business aspects of a PACE team of 200 participants or more. Manages all administrative functions related to running a PACE center. Responsible for hiri

The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

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

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

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