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Fallon Health Clinical Quality Management and Analyst Nurse - Growing MLTC in Amherst, NY, New York


F allon 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 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 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 www.fallonhealth.org .

Fallon Health Weinberg-MLTC:

Fallon Health Weinberg-MLTC is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg a Managed Long Term Care (MLTC) is a plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high quality, affordable health care.

Is responsible for supervising the quality and risk management activities of the MLTC Program. Efforts

are focused on the development of systems for collection of clinical and other quality data, analysis and

interpretation of data, and implementation and monitoring of corrective action plans. Provides clinical expertise and

technical support for quality initiatives. Develops and maintains clinical quality databases. Develops reports and

communicates with internal and external customers as needed


Provides support to the Quality and Performance Improvement Program,Performance Improvement

Committees and Quality Design Teams including but not limited to the following activites: assistance with

the scheduling and coordination of subcommittee meetings; preparation of meeting agendas; preparation of

meeting minutes; committee correspondance and follow-up; development and implementation of annual

work plans; provision of data and clinical management support for focused studies including measurement,

analysis and reporting of data; assistance with maintenance of up to date documentaiton of committee/team

activity in the preparation of annual evaluations, work plans and quality improvement activity forms.

• Participate in the design, collection of data, analysis and reporting of clinical quality projects and quality

initiatives as listed in the quality description; prepares high end reports for the FHW Service and Quality

Oversight Committee and other outside agencies as necessary (such as Medicaid).

• Participates in the survey prosess at FHW and maintains necessary documentation, binders and logs as

required by regulation (such as the infection control log).

• Maintains and oversees the staff in-service and training which includes coordination of new hire orientation,

initial and annual competencies/skill lists for clinical employees (nurses, health aides, social service, activities)

and schedules required annual in-services on all staff.

• Performs medical record reviews on a quarterly and annual basis in all FHW settings to include providers

including, but not limited to, day centers, nursing homes, home care, transporation and alternative sites.

Monitors and maintains data bases as listed in the quality work plan from QUM, annual and monthly

satisfaction surveys, grievances, incident reports and infection control.

• Oversees the completion of the MLTC state required reporting submissions and the tracking of these.

• Coordinates FHW MLTC policy and procedure manuals to support the continuous performance improvement

process and the quality of service provided by the department.

• Oversees FHW Infection Control Program and log.

• Oversees FHW Risk Management Program including the tracking and trending of incidents to identify

opportunities for quality improvement.

• In collaboration with the Program ensures compliance with all regulatory and contractual requirements of NY


• Creates business requirement documents for new or enhanced program reporting. Performs data validation

on new and existing reports.

• Contribute to development of new porgram intitatives and report elements as the prorgram. Maipulates,

prepared and distributes various reports utilized to evaluate the Program/staff performance including but

not limited to elements associated with regulatory compliance, productivity, dashboard reporting and


• Performs sytem testing to ensure functionality, performance, reliability, stability and enhancements to the

plan electronic medical record systems.

• Evaluate data collections and methodologies, including format design, project criteria and requirements, data

compilation, relevancy and usage based on and related to user or system design specifications

• Identify, analyze, and interpret trends or patterns in complex data sets to prepare presentations for the

MLTC leadership and plan staff.

• Assist with resolving the findings of the audit or project, drafting the final report and helping develop a final

system for the Program related to audit requirements

• Serve as a systems/data and reporting resource within the program by maintaining a high degree of visibility

within the business and attending business meetings and appropriate management forums, providing a

central point of information for all related program activities

• Develops ad-hoc reports as necessar


Education, Licenses, certification and

experience requirements:

Education: Degree in nursing required

License: RN

Certification: Certified Care Manager a plus.

Experience: Minimum of 1 year related experience in

a healthcare setting preferably with a geriatric

population. Minimum of 1 year experience with

Managed Care insurance. Quality

Management/Performance Improvement experience

preferred. Experience with analyzing data equired. Strong

knowledge of Microsoft Word, Power Point and Excel

required. Exeperiance with Microsoft Access, relational

databases a plus.


• Demonstrates commitment to the Fallon Health

Weinberg Plan Mission, Values and Vision.

• Proficient communication skills.

Location US-NY-Amherst, NY

Posted Date 4 months ago (5/25/2022 12:59 PM)

Job ID 6874

# Positions 1

Category Nursing