Fallon Health RN Clinical Director-Fallon Health Weinberg - Amherst, NY in Amherst, NY, New York
Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) 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.
Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all they serve. It consistently ranks as one of the nation's highest-rated health plans, according to the National Committee for Quality Assurance (NCQA).* Fallon Health coordinates care with its Senior Care Options/Special Needs Plan for dual-eligible people who are 65 and older. Fallon Health has operated a PACE program in Massachusetts for more than 20 years and is the largest PACE program in New England and sixth largest nationally.**
Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus. The two parent companies, Fallon Health and Weinberg Campus, have demonstrated consistent commitment to providing an array of solutions that make high-quality, integrated and affordable care more accessible to the poor, disabled and senior populations within the communities they serve.
Director of FHW Clinical Service is accountable for the clinical direction and management of the services of Fallon Health Weinberg MLTC within the FHW service area, including the development, implementation, maintenance and monitoring of all clinical programs and operations as required in the Model of Care contracts between.
FHW and the Centers for Medicare and Medicaid Services (CMS). The Director works closely with members of the FHW leadership team and the Program Director in developing and administering the clinical program to ensure compliance with all relevant aspects of the CMS and NY State Medicaid managed long term care Program.
Be an energetic leader, dedicated to company’s mission and core values, with a track record demonstrating accountability for results.
Be a subject matter expert on the clinical and care management of diverse populations.
Demonstrate extensive experience with regulatory and accreditation bodies.
Strong leader who builds and guides world-class teams to success. Adept at dealing across organizations and with multiple stakeholders.
Have significant experience in leading multidisciplinary internal and external.
Be an effective liaison with providers, advocacy groups and industry experts to stay on the leading edge of innovation and advances in health care reform.
Have an excellent ability to work with regulatory agencies.
Possess vision, as well as a strong capability for on-the-ground implementation.
Be a strategic, tactical and analytical thinker.
Have a track record as an accomplished clinical professional.
Be able to make decisions in a changing environment.
Effectively oversee and lead all activities for the Fallon Health Weinberg HMO-snp/MLTC clinical programs and department staff.
Responsible for the member appeals and grievances, and customer service issues for members enrolled in the FHW MLTC program and HMO-snp.
Oversees integrated clinical assessment, care plan development and implementation, care coordination, case management, health, and wellness activities, health outcomes improvement, medical policy development, utilization management, grievances and appeals.
Implement clinical program specific action plans, strategies and timelines
Manage all resources so as to meet clinical program performance goals, targets and standards. Key performance targets include but are not limited new member outreach and orientation; management of services and benefits as provided directly by clinical program staff or via a delegated and/or matrix relationship with other programs (i.e., medical and behavioral health management programs); and ensuring active participation and collaboration between program staff, Clinical Operations staff, the member’s PCP and the members of the integrated care team (ICT)
Actively coordinate clinical program initiatives/activities with the government services quality director, shared services (i.e., utilization management and case management functions), and delegated vendors.
Develop and maintain a collaborative working relationship with leadership staff with in Fallon Health Weinberg Establish and maintain effective and collaborative relationships with other key internal and external customers and constituencies.
Respond to clinical program specific inquiries and/or requests from the Program Director, consistent with corporate and/or department policy
Recruit, hire, train, retain and evaluate department staff. Leads staff in the achievement of high quality performance and team orientation. Insure staffing needs are met and that clinical staff is always fully credentialed and licensed with no restrictions.
Establish productivity and professional goals with staff and evaluated performance based on these defined goals.
Conduct staff meetings and meet with individual staff on a regular basis
Create, implement and modify department processes as necessary.
Strictly observe the HIPAA regulations and the policy regarding confidentiality of member information
Leads the development and implementation of quality improvement and care management programs, outcomes measurement and analysis and accreditation activities.
Collaborates with Integrated Care Team to develop creative solutions to challenging care situations. Participates in interdisciplinary care team discussions to improve operations and overall optimal member care.
Engages, educates and supports Fallon Health Weinberg provider groups in appropriate and effective utilization and care management practices for the dual eligible population.
Embraces technology to advance the quality and efficient delivery of care.
Regularly consults with outside agencies, organizations and experts to ensure incorporation of most recent physical and behavioral care standards for the population served.
Ensures compliance with all regulatory and accreditation requirements.
Other duties that may be required to complete projects
BSN or Master’s degree in Public Policy, Health Policy, Health Administration, Business Administration or Science highly preferred. * *
current driver’s license
Experience in managed care, health care, health policy and/or health law a plus
experience in consulting to, managing or leading government programs beneficial
Previous experience with NY Medicaid programs, , CMS, IPA’s, ACO’s and Medicare Advantage programs beneficial
Previous management experience required
Experience with care management required
Previous experience with Home/community based service beneficial
Job ID 5642
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