Manager, Pace Operations Support

2 weeks ago

Worcester, United States Fallon Health Full time

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.

**Brief summary of purpose**:
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. The Manager supports the Senior Director, PACE Operations to manage program level operational and regulatory functions in support of the program’s quality, strategic and financial goals. Responsible for supporting PACE sites related to the development and implementation of processes and workflows, network development, contract management, claims, billing, and authorization assistance. This position requires regular travel to all Summit ElderCare sites and occasional travel to FHW PACE to provide support/guidance on various operational topics. Travel = 10% of the time

**Responsibilities**:
**Primary Job Responsibilities**

**Is responsible for ensuring accurate payment of the PACE medical claims**:

- Responsible for managing the SE QNXT claim inventory
- Responsible for following up with Supervisors of Support Staff to ensure that the pended claims are being processed timely
- Responsible for reviewing authorization issues that result in incorrect payment and working with site staff to resolve issues in a timely manner
- Responsible for ensuring that necessary training is conducted so that office staff is able to complete daily billing and claims responsibilities
- Works with FH UM, Provider Relations, and Claims departments to troubleshoot authorizations and claims issues

**Is responsible for overseeing the PACE Service Coordination Unit**:

- Responsible for managing and supervising the SE Service Coordinators
- Responsible for ensuring SE Service Coordinators are working quickly to secure needed home care services for PACE participants
- Responsible for conducting random call audits on a regular basis to ensure quality customer service and appropriateness of call content
- Responsible for ensuring that necessary onboarding, training, ongoing regular supervision/touchpoints and, if needed, performance management, is carried out with all Service Coordinators
- Has regular communication with external home care vendors and Service Coordination Unit to ensure good business partnerships
- Works with site teams to ensure Service Coordination unit receives the needed information in order to secure appropriate in-home services for PACE participants

**Committees & Workgroups**:

- For assigned meetings, prepares agenda in collaboration with Senior Director, PACE Operations
- Responsible for meeting follow ups
- Records meetings, documents key points and necessary follow up, sends out link to meeting minutes in a timely manner to all attendees

**PACE Member Satisfaction**:

- Reviews monthly SE satisfaction surveys
- Responsible for following up with the sites to resolve participant and caregiver issues/concerns
- Attends the monthly FH Service Advisory Committee meeting as PACE representative and reports on satisfaction survey scores below 9 as well as other Service Quality related topics
- Attends SE Service Quality Meeting quarterly and works with SE leadership and PACE sites to plan interventions and improvement activities for increasing Participant satisfaction scores, reports back to FH Service Advisory Committee

**Conduct systemic monitoring of pended claims inventory**:

- Communicates with relevant PACE sites and monitors for resolution
- Strives to improve processes while leveraging assistance and resources from other Fallon Health departments
- Support ongoing adherence to Summit ElderCare billing policies and procedures
- Ongoing interaction and coordination with FH Enrollment and Billing Operations, Medicaid C

  • Desktop Support Technician

    1 week ago

    Worcester, United States Cynet Systems Full time

    Job Description: Responsibilities: Provide customer facing end-user support that includes: Break-fix support for Laptop, desktop, tablets and associated hardware peripherals. IMAC support including large scale/bulk office moves/re-stack activities (all moves). Support for Operating System, base load software, MS Office suite and other business...

  • Senior IT Support Engineer

    2 weeks ago

    Worcester, United States Machado Consulting Full time

    Job DescriptionJob DescriptionSalary: NegotiableIMMEDIATE POSITION AVAILABLEReactive Support EngineerSenior IT Support Engineers are the last line of defense within the IT Support department. Responsibilities include responding to escalated tickets via phone or email and assisting IT Support Technicians with tickets they may have questions on but don’t...

  • Assistant Manager

    7 days ago

    Worcester, United States Domino's Full time

    DOMINO'S TEAM ELITE IS LOOKING FOR FUTURE MANAGERS IN THE BOSTON AND METROWEST AREA! DOMINO'S IS A FUN, EXCITING, FAST PACED ENVIRONMENT! APPLICANTS MUST BE MOTIVATED, HARD WORKING, AND HONEST WITH A POSITIVE ATTITUDE WHO ARE LOOKING TO GROW IN A HIGH PACED ENVIRONMENT. START AS AN ASSISTANT MANAGER AND GROW TO A MANAGER. ASSISTANTS START AT AN HOURLY RATE...

  • IT Support Specialist

    2 weeks ago

    Worcester, United States Nouria Energy Full time

    Position : **IT Support Specialist - II** Location : Worcester, MA (Nouria's corporate office) Summary : Nouria Energy is looking for an IT Support Specialist-II to join our team. This position will be providing direct technical support to our end-users including serve as tier 2 support role for handling escalated issues. This includes taking ownership for...

  • Operations Supervisor, 2nd Shift M-F 2pm-10:30pm

    1 week ago

    Worcester, United States CareerBuilder Full time

    Company Description AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas - immunology, oncology, neuroscience, and eye care - and products and services in...

  • Network Infrastructure Manager

    Found in: Talent US C2 - 1 week ago

    Worcester, United States The Hanover Insurance Group Full time

    POSITION OVERVIEW: Reporting to the Director of Data Network Services, the Network Infrastructure Manager will lead a team of Managed Service Provider (MSP) engineers, employees, and contractors with diverse skills that collectively deliver reliable and scalable network infrastructure platforms. The network infrastructure engineering and operations...

  • Program Manager Home Health

    7 days ago

    Worcester, United States Boston Healthcare Management Llc Full time

    Job Description Job Description We are seeking a Program Manager Home Health to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients.Responsibilities:Administer nursing care to ill, injured, or disabled patientsDiagnose and establish patient treatment plansMonitor and report changes in patient symptoms or...

  • Program Manager Home Health

    2 weeks ago

    Worcester, United States Boston Healthcare Management Llc Full time

    Job Description Job Description We are seeking a Program Manager Home Health to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients. Responsibilities: Administer nursing care to ill, injured, or disabled patients Diagnose and establish patient treatment plans Monitor and report changes in patient symptoms...

  • Project Manager

    2 weeks ago

    Worcester, United States The Fountain Group Full time

    The Fountain Group is a national staffing firm we and are currently seeking a Project Manager II and Project Manager III for a prominent client of ours. This position is in Worcester, MA . Details for the position are as follows: Job Description: PM II: $77 - $82/hour PM III: $105 - $112/hour This is a Quality Engineer or Technical Project Manager....

  • Desktop Support Analyst

    5 days ago

    Worcester, United States Tata Consultancy Services Full time

    Job Title: Desktop Support Engineer Location: Worcester MA Roles & Responsibilities: Proven experience as an IT Support Specialist or similar role. Strong knowledge of Windows 10 and O365 environments. Experience using Active Directory, Office 365 products. Familiarity with ITIL practices and ticketing systems. Administering various Microsoft products,...

  • Desktop Support Lead

    6 days ago

    Worcester, United States Tata Consultancy Services Full time

    Role: EUC Desktop Support Skills: Desktop Support, Troubleshooting, Office 365 Job Type: Fulltime Location: Worcester, MA/ Itasca, IL/ Howell, MI/ San Jose, CA/ Scottsdale, AZ/ Omaha, NEB (Onsite) Job Description: Proven experience as an IT Support Specialist or similar role. Strong knowledge of Windows 10 and O365 environments. Experience using Active...

  • Program Manager Home Health

    2 weeks ago

    Worcester, United States Boston Healthcare Management Llc Full time

    Job DescriptionJob DescriptionWe are seeking a Program Manager Home Health to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients.Responsibilities:Administer nursing care to ill, injured, or disabled patientsDiagnose and establish patient treatment plansMonitor and report changes in patient symptoms or...

  • Desktop Support Lead

    Found in: Appcast Linkedin GBL C2 - 1 week ago

    Worcester, United States Tata Consultancy Services Full time

    Role: EUC Desktop SupportSkills: Desktop Support, Troubleshooting, Office 365Job Type: FulltimeLocation: Worcester, MA/ Itasca, IL/ Howell, MI/ San Jose, CA/ Scottsdale, AZ/ Omaha, NEB (Onsite)Job Description:Proven experience as an IT Support Specialist or similar role. Strong knowledge of Windows 10 and O365 environments. Experience using Active Directory,...

  • Desktop Support Lead

    Found in: Appcast US C2 - 1 week ago

    Worcester, United States Tata Consultancy Services Full time

    Role: EUC Desktop SupportSkills: Desktop Support, Troubleshooting, Office 365Job Type: FulltimeLocation: Worcester, MA/ Itasca, IL/ Howell, MI/ San Jose, CA/ Scottsdale, AZ/ Omaha, NEB (Onsite)Job Description:Proven experience as an IT Support Specialist or similar role. Strong knowledge of Windows 10 and O365 environments. Experience using Active Directory,...

  • Regional Group Fitness Manager

    2 weeks ago

    Worcester, United States Fitness Holdings North East LLC Full time

    Job DescriptionJob DescriptionDescription:Crunch Fitness is looking for energetic, enthusiastic people that are passionate about health and fitness to join our team!Crunch is a gym that believes in making serious exercise fun by fusing fitness and entertainment and pioneering a philosophy of No Judgments. Our gyms are packed with the latest state-of-the-art...

  • Divisional Office Manager

    Found in: Talent US 2 C2 - 2 weeks ago

    Worcester, United States Massachusetts District Court Full time

    Main content Job Details for Divisional Office Manager Court Name/Organization: Massachusetts District Court Overview of the Position: The U.S. District Court Clerk’s Office is accepting applications for a full-time Divisional Office Manager in the Worcester Office. This office supports one U.S. District Judge and one U.S. Magistrate Judge. The...

  • Community Support Services HI Case Manager

    3 weeks ago

    Worcester, United States South Middlesex Opportu Full time

    Job DescriptionJob Description SUMMARYProvide case management services to participants in a program serving homeless individuals residing at the Emergency Triage Center in Worcester. Case management includes an initial and ongoing assessment with regular follow up and referrals/linkages to community-based services. The primary goal is to achieve client...

  • Safety Manager

    1 week ago

    Worcester, United States Manafort Brothers Full time

    We are seeking individuals with experience in all aspects of construction safety to perform safety audits, training and risk evaluation. Experience with industrial hygiene including familiarity with personal exposure sampling techniques is required. This position will be based out of our Cumberland, RI; and Worcester, MA (Manafort-Precision, LLC) offices....

  • Manager of Institutional Giving

    1 week ago

    Worcester, United States Family Health Center Full time

    Job Description Job Description POSITION SUMMARY: Family Health Center of Worcester seeks to hire a Manager of Institutional Giving to expand efforts in securing new and maintaining existing grant funding to support programs, operations, and capital needs. Family Health Center of Worcester is a Federally Qualified Community Health Center that provides care...

  • Manager of Institutional Giving

    2 weeks ago

    Worcester, United States CareerBuilder Full time

    Job Description Job Description POSITION SUMMARY: Family Health Center of Worcester seeks to hire a Manager of Institutional Giving to expand efforts in securing new and maintaining existing grant funding to support programs, operations, and capital needs. Family Health Center of Worcester is a Federally Qualified Community Health Center that provides care...