ACO Community Partner (CP) and Flex Program Coordinator
: Job Details :

Overview:

About us:

Fallon Health is a company that cares. We prioritize our membersalwaysmaking sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nations top health plans for member experience, service, and clinical quality. 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 programsincluding Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly) in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The Accountable Care Organization (ACO) Community Partner (CP) and Flex Services Program Coordinator assists in the management of the Behavioral Health (BH) Community Partner (CP) Program, Long Term Services and Supports (LTSS) Community Partner Program, and Flexible Services Program, acting as an end point of contact for the BH CPs, LTSS CPs. & Flexible Services Agencies.

The coordinator may make face-to-face visits with Agencies and work with the Manager to establish and develop collaboratively working relationships including facilitating member review with the Agencies and the ACO Partner and Fallon Health Care Teams.

Responsibilities include but are not limited to:

• Managing files between the State, Fallon Health, the ACOs, and the BH and LTSS Community Partner Organizations
• Collaborate with ACO and ACO partners regarding members involved with BH and LTSS CP
• Communicate with CP Partners and Flexible Services agencies regarding referrals for BH and LTSS CP and Flexible Services Programs
• Assist in implementation of functions between the ACO and CP Partners
• Assist in providing performance management to BH and LTSS CP related to contracts
• Monitor and coordinate response to inquiries made to Central CP inbox

The ACO CP & Flex Services Program Coordinator works closely with Manager, ACO Community Partner and Flex Program, Community Partners from both Behavioral Health and Long-Term Service and Support agencies and the staff at the Provider Accountable Care Organizations. The ACO CP Program Coordinator refers to the Fallon and ACO Care Managers whenever clinical decision making is required.

Responsibilities:

Primary job responsibilities:

• Directs communication with Community Partners (CPs), Flexible Service Organzations, Accountable Care Organizations (ACOs) and the State (Executive Office of Health and Human Services EOHHS)
• Processes referrals and assist in assigning members to the appropriate BH and LTSS CP or Flexible Services Program
• Responds to questions or concerns about members referred to BH and LTSS CP
• Researches and corrects issues regarding member enrollment in CPs
• Engages in discussions with Fallon and ACO Care Managers about members assigned, engaged, or lost to care

• Develops rosters for BH and LTSS CP
• Develops reports for BH and LTSS CP about assigned members and status of these members
• Facilitates performance management with ACO and MCO ensuring BH and LTSS CP are meeting all requirements of contracts
• Attends EOHHS meetings as required
• Assists in scheduling and managing agendas for CP meetings
• Attends BH and LTSS CP meetings virtually and in person as required
• Assists in preparation and review of reports for EOHHS and Community Partners

Performs other responsibilities as assigned by the Manager/designee.

Qualifications:

Experience:

2-4 years job experience in a health-care related field or in a behavioral health setting. Experience working with behavioral health community partners (CPs) and Long-Term Service and Support (LTSS) providers.

Additional performance requirements:

• Excellent communication and organizational skills;
• Ability to multi-task and manage competing priorities
• Critical thinking skills for independent problem solving;
• Experience coordinating and collaborating with multiple internal/external stakeholders coordinate and collaborate with CP Partners;
• Capable of merging, synthesizing and validating data from multiple sources;
• Ability to conduct accurate and timely data entry.

Resources (systems, etc.) used in performing role

Microsoft products (Word, Excel, Visio, PowerPoint, Outlook); MS Teams; reporting software such as Business Objects; CaseNET TruCare System; QNXT System, Provider EMRs as applicable, State Virtual Gateway system and other systems used to complete work.

COVID-19 Vaccination:

With the end of the Global Coronavirus COVID-19 Pandemic, Fallon Health no longer requires all employees to be vaccinated against COVID-19 except for employees who are in jobs that under state and federal laws, regulations and policies are required to be vaccinated and/or they are in Member/participant facing positions.

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.