Job Description

Overview

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.

About Summit ElderCare:

Fallon Health operates the largest Program of All-Inclusive Care for the Elderly (PACE) in New England and the fifth largest in the country. Called Summit ElderCare, Fallon’s PACE helps provide older adults and their caregivers with a welcome alternative to nursing home care. Participants in Summit ElderCare have access to comprehensive medical services and social support at a Summit ElderCare site while they keep the independence of living in their own homes and communities.

Responsibilities

Responsible for the oversight of the site specific Rehabilitation Department. Oversees rehabilitation services provided to SE participants in accordance with applicable regulations as well as FH and SE policies and procedures. Responsible for assuring that the rehabilitation needs of participants are assessed and met either through the use of SE staff or through coordination of care with contracted vendors. Performs assessments, participates in care planning and provides direct care for program participants.

• Performs all managerial functions to ensure adequate and appropriately skilled staff and resources are available to provide all PACE related services, including but not limited to, hiring, training and evaluation of rehabilitation services personnel.
• Coordinates the provision of rehabilitation services.
• Assures that assessments are completed and documented to identify rehabilitation service needs in a timely manner.
• Works in collaboration with the interdisciplinary team (IDT), participants and caregivers to determine and meet participants’ rehabilitation needs.
• Participates in daily IDT meetings and care planning meetings as scheduled.
• Assures that care plan revisions are documented in the participant’s record and communicated in a timely manner; supervises implementation as necessary.
• Documents all direct care encounters in the EMR to facilitate submission of claims and diagnostic data to FH systems.
• Delegates work to SE rehab staff according to their scope of practice, by establishing work assignments and coordinating staff schedules.
• Assures assessment and treatment of participants in their home setting as needed.
• Collaborates with the Home Care Manager to assure that home safety evaluations are completed in a timely manner, information is communicated to the IDT and follow-up of identified recommendations occurs.
• Collaborates with the Home Care Manager to assure in-home equipment needs are met.Develops and implements processes for managing in home equipment quality and cost management.
• Completes all rehabilitation services related data collection and quality surveillance as required.
• Conducts regular staff meetings and staff supervision as appropriate.
• Responsible for the timely completion of staff touchpoint meetings, performance evaluations and competencies. Addresses employee relations and performance issues immediately and directly
• Responsible for ensuring timely and accurate review of rehabilitation service claims and prior authorizations and submission of approvals to the FH Claims Department.
• Assures that corrective action plans are completed for incident/grievance reports related to rehabilitation services.
• Achieves Utilization Management, MLR & cost of care targets

Qualifications

• Graduate of an accredited program in Physical or Occupational Therapy.
• Licensed as a physical or occupational therapist in Massachusetts     
• CPR certification or willingness to obtain

Access to reliable transportation to perform work throughout the PACE center’s service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

• Driving a motor vehicle is an essential job function of this position and the following requirements apply:
• Must possess a valid drivers’ license and have a satisfactory drivers’ record report
• Must maintain the minimum state required insurance as referenced in Fallon Health’s Drivers’ Safety policy, on the vehicle you use while performing company business
• Must have reliable transportation
• Must meet the requirements of Fallon Health’s Drivers’ Safety Policy

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