Serves as a member of the PACE interdisciplinary team assessing the needs, interests, and capabilities of participants and developing individualized therapeutic recreational care plans based on individual diagnoses and assessments. Plans, organizes, directs, and participates in a comprehensive therapeutic recreation program tailored to the general and individualized needs

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

Responsible for processing, verifying, and reconciling Accounts Payable invoices. Responsibilities Primary Job Responsibilities AP processing for FCHP and overall functionality of Oracle AP Enter/Scan all accounts payable invoices into Oracle and analyze and pay vendor accounts according to invoice terms, either PO or GL account costing Ensure AP invoice and backup approv

The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health's 1 800 numbers, as well as providing direction on Plan policies, procedures, and benefits. Some key responsibilities include Ownership for development of knowledge and skills, as training program provides material and framework for su

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. Competencies Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision. Specific competencies essential to this position Customer Focus Commitment Through Acti

Perform a variety of medical records responsibilities. All appoint functions for our participants at the day center and prospective enrollees. In collaboration with clinic staff, establish own work plan and priorities, using and/or modifying established procedures to assure timely completion of assigned work in conformance with established departmental policies and standa

Summit Rehabilitation Manager Great Role Between Framingham and Worcester! Location US MA Worcester Job ID 8477 # Positions 1 Category Medical Management Overview 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 insuran

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

Provides personal care, light housekeeping, and assistance with ADLs (Activities of Daily Living) as outlined in each Summit Eldercare 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

Provides personal care, light housekeeping, and assistance with ADLs (Activities of Daily Living) as outlined in each Summit Eldercare 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

The SIU Code Auditor will conduct coding audits of medical records provided by providers to check for missing documentation and other medical documentation for E&M, DME, medical, home health services, and may include some behavioral health care services to identify potential over payments and suspected fraud waste and abuse. Serve as a clinical and code liaison for fraud,

The primary role is to provide high quality, cost effective medical care to program participants in accordance with the program mission and participant goals. Responsibilities P rimary Job Responsibilities (include duties that represent 5% or more of employee's time) Support the intake and enrollment process by meeting with participants and caregivers to represent the pro

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

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 Competencies Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision. Specific competencies essential to this position Customer Focus Commitment Through Actio

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 Competencies Demonstrates commitment to the Fallon Community Health Plan Mission, Values and Vision. Specific competencies essential to this position Customer Focus Commitment Through Actio