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Fallon Health Behavioral Health Program Operations Coordinator - Flexible Remote in Worcester, Massachusetts


Fallon 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 fallonhealth.org.

Brief summary of purpose:

The Behavioral Health (BH) Program Coordinator is accountable for the daily management and coordination of Fallon Health BH services.The responsibilities include working closely with the BH Vendor Relations Manager on the maintenance, monitoring and reporting for all programs and operations as required for the Fallon Health BH Program.The Coordinator serves as the Key Contact as it relates to behavioral health issues, including assisting the BH Clinical Integration Team with day-to-day functions including report monitoring and supporting the resolution of BH provider/member/claim issues.


Primary Job Responsibilities:

Daily Management and Coordination of Fallon Health BH services:

  • Acts as a point of contact for the BH team to assist Fallon in resolution of BH claim-related issues, including claims payment issues, provider contract-related issues and member eligibility issues

  • Coordinating meetings between the BH vendor and Fallon staff to facilitate issue resolution, e.g., data exchange improvements and claims issues, in addition to participating in resolving those issues and tracking working to completion

  • Monitor the delivery of all monthly, quarterly and annual reporting deliverables from the BH vendor, review the reports, distribute appropriately and escalate any issues associated with submissions to BH Director of Operations

  • Act as organizational resource for contractual and benefit questions associated with the BH program and products

  • Coordinate and ensure timely response to all BH inquiries and requests, working collaboratively with the BH vendor as well as all departments within Fallon Health

  • Assisting with the management of daily operational activities as assigned

Work with the BH Vendor Relations Manager on the maintenance, monitoring, and reporting for all programs and operations of the BH Program:

  • Review all federal and state communications related to behavioral health, identify the impact to the BH vendor and the impacted internal departments, ensure proper distribution of this information, and provide tracking of action is to be taken on the part of the BH vendor

  • Develop and maintain a system for continually tracking and monitoring BH-related deliverables

  • Assists the BH and Clinical Integration Team with developing and executing ad hoc report requests containing BH components

  • Monitor the schedule of deliverables against the program’s priorities and timelines including communicating delays and schedule changes to the BH team

  • Acts as the point of contact for review, assessment, and delivery of monthly, quarterly and annual BH reporting to the designated stakeholders

  • Ensure appropriate BH Fallon Representation for any MassHealth meeting

  • Develop and maintain a departmental schedule for BH state meetings, detailing purpose and confirmed attendees

  • Develop and maintain a collaborative working relationship as key contact (liaison) between Fallon, BH Vendor and MassHealth



BA or BS




  • 3 years’ experience in managed care, government programs or health care preferred

  • Demonstrated strong organizational skills required

  • Experience with managing project implementations

  • Demonstrated strong interpersonal skills required

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.


Location US-MA-Worcester

Posted Date 1 month ago (5/24/2022 4:42 PM)

Job ID 6872

# Positions 1

Category Behavioral Health