**Overview** **About us:** Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality. Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, 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 programs—including Medicare, Medicaid, and PACE— in the region. **Brief Summary of purpose:** Responsible for: + Development and revision of PACE Home Care related policies and procedures across the program + The oversight of the site’s homecare department and provision of all in-home nursing services provided by site nursing staff. + Assuring that the home care needs of participants are assessed and met either by SE-employed staff or through coordination of care with contracted home care vendors. + The coordination and supervision of care for participants in the various Summit Eldercare Supportive Housing Program apartments as applicable. Functions independently in the day-to-day management of the home care department to assure that participants’ home service needs are met. Performs functions in adherence with Fallon Health and Summit ElderCare policies and procedures, State and CMS regulatory guidelines, leadership guidance and program goals **Responsibilities** **Primary Job Responsibilities:** + Coordinates the provision of home care services. + Assures that initial and periodic assessments are conducted to identify in-home service needs. + Participates in the development of participants’ care plans. + Provides direct oversight to Home Care RNs who work in collaboration with SE providers, interdisciplinary team (IDT), participants, and caregivers to determine and meet participants’ home care needs. + Assures that care plan revisions are communicated in a timely manner to agencies and SE home care staff; supervises implementation as necessary. + Conducts vendor audits as assigned, in compliance with PACE/CMS requirements. + Assumes responsibility for instruction and supervision of nursing staff, health aides and Service Coordinator. + Delegates work to home care staff, according to their scope of practice, by establishing work assignments and coordinating staff schedules. + Performs home care visits and inin-home assessments of assigned panel of participants and for others in the absence of assigned Home Care RN. + Ensures placement and 60-day supervision visits for all employed home health aides are completed in a timely manner to facilitate ongoing home care needs of SE participants + Assures that home safety evaluations are completed in a timely manner and information is communicated to the IDT. + Assures that assessments, reassessments, and home care services are documented in an accurate and timely manner in the EMR. + Collaborates with rehabilitation department to secure in-home equipment to meet participants’ needs. + Assures that changes in participant status/needs are communicated to home care staff/agencies in a timely manner. + Actively participates in IDT morning meetins, huddles and family meetings. + Oversees data collection and quality surveillance as required. + Collaborates with the Site Director to establish goals and objectives related to home care services. + Onboarding of newly contracted Home Care agencies + Conducts Enrollment Home Visits as needed in the absence of the primary Enrollment Coordinator RN or when home visit volume requires additional assistance. + In addition to SE Worcester, provides assistance to other SE sites with intakes. Fulfills RN role of Intake Process when volume requires additional resources to ensure timely intake and enrollment decisions for Summit ElderCare sites in Worcester County (i.e., SE Leominster and SE Webster) **Administrative:** + Responsible for interviewing potential candidates for open positions and hiring new staff. + Facilitates new staff orientation. + Conducts regular staff meetings and touchpoint meetings with all direct reports. + Responsible for the timely completion of performance evaluations and staff competencies. + Establish individual goals for all direct reports and reviews progress periodically. + Responsible for the completion and submission of biweekly payroll. + Responsible for reviewing all claims and prior authorizations for accuracy. + Addresses employee relations and performance issues immediately and directly. Administers disciplinary actions as required in collaboration with Site Director and HRBP as appropriate. + Assures that corrective action plans are carried out for incident/grievance reports related to home care services. + Responsible for oversight of care provided for participants living in Supportive Housing apartments. Performs all duties in accordance with Fallon Health and Summit ElderCare policies and procedures.  **Qualifications** **Education** Graduate of an accredited school of nursing. Bachelor of Science in Nursing preferred.      **License/Certifications** **License** : License to practice as an RN in the state of Massachusetts. **Certification** : CPR certification Reliable transportation required to facilitate necessary travel throughout site service area and corporate office. **Experience** + At least two years experience working with geriatric population in a healthcare setting. + Minimun 2 years management and supervisory experience in home care or community health; nursing required.       + Proficiency in IV and phlebotomy helpful **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.** **Location** _US-MA-Worcester_ **Posted Date** _3 weeks ago_ _(10/25/2024 5:23 PM)_ **_Job ID_** _7732_ **_\# Positions_** _1_ **_Category_** _Medical Management_