WorcesterRecruiter Since 2001
the smart solution for Worcester jobs

Clinical Integration Navigator-Central MA

Company: Fallon Community Health Plan
Location: Worcester
Posted on: January 15, 2022

Job Description:

Clinical Integration Navigator-Central MAUS-MA-WorcesterJob ID: 6681Type: Full Time# of Openings: 1Category: Administrative/ClericalFallon Health - Corp HQOverviewFallon 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. About Fallon HealthFounded 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 insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.About NaviCare:Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member's health care by working with each member, the member's family and health care providers to ensure the best possible outcomes. The Navigator 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. Passionate about Helping People? Enjoy working with the Elderly? Looking for No Weekends/ No Holidays & Work/Life Balance? Live in the Berkshires?Care Coordinator or Navigator position covers Greater Worcester. Brief summary of purpose:The Care Coordinator or Navigator partners with Fallon Health Care Team staff and other providers to communicate at all times what is occurring with the member and their status. The Care Coordinator or Navigator seeks to establish telephonic and face to face (depending upon product and circumstance) relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member specific care plan. In order to effectively advocate for member needs, the Care Coordinator or Navigator may make in home or facility visits (depending upon the product and circumstances) with or without other Care Team members to fully understand a member's care needs. ResponsibilitiesResponsibilities include but are not limited to: Coordinating care and community-based services for members of the NaviCare programCentral point of contact for member and providers, facilitating to meet member needs and transitionsConducting telephonic assessments and may conduct face to face member visits to assess members utilizing TruCare Assessment ToolsMaintaining member records- including but not limited to adhering to CMS regulatory requirements, documentation, outreaching to members to educate and coordinate clinical/preventative screeningsEstablishing and developing effective working relationships with community partners such as housing staff, adult day health care staff, assisted living staff, group adult foster and adult foster care staff, rest home staff, long term care facilities and other providers including primary care providers with the goal to facilitate member specific communication, represent Fallon Health in a positive and effective manner, and work to grow membership in the various Fallon Health products as applicableQualificationsEducation: College degree (BA/BS in Health Services or Social Work) preferredLicense/Certifications: Current MA Driver's License and reliable transportation. No certifications are required.---Other: Satisfactory Criminal Offender Record Information (CORI) results. Experience:2+ years job experience in a managed care company, medical related field, or community social service agency requiredUnderstanding of hospitalization experiences and the impacts and needs after facility discharge requiredProficient in Microsoft Office applicationsKnowledge of computer-based phone system preferred 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. PM16PI160578367

Keywords: Fallon Community Health Plan, Worcester , Clinical Integration Navigator-Central MA, Healthcare , Worcester, Massachusetts

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Massachusetts jobs by following @recnetMA on Twitter!

Worcester RSS job feeds