25 jobs found in worcester

NaviCare Account Sales Representative - Russian or Hindi Preferred US-MA-Worcester Job ID: 5947 Type: Full Time # of Openings: 1 Category: Sales Fallon Health - Corp HQ 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 www.fallonhealth.org . About NaviCare : Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. A personalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes. Position Overview: This position requires that the Account Executive achieves personal referral and outreach goals for the NaviCare program. Manages a territory and group of referral source accounts, providing regular follow up and overcoming barriers with each account to meet enrollment goals. Responsibilities Relationship Building Creates productive and collaborative relationships with internal and external referral sources in order to obtain qualified referrals and enrollments for the NaviCare program. Participates in all community outreach activities, such as senior fairs, community events, and elder services professional association events to ensure Fallon Health’s visibility and presence in your territory. Presents the NaviCare program to groups who are likely prospects, caregivers and community referral sources. Develops and implements their own territory business development plan, and carries out activities to penetrate accounts listed on the plan. Lead Generation Works collaboratively with NaviCare enrollment team to discuss progress of referrals and ideas for resolving issues. Provides in-service orientations to vendors and providers on an annual basis. Shows accountability and follows up with prospects until the lead is closed/withdrawn and document as appropriate. Achieves monthly referral and home visit request goals Secure Applications Generates sufficient NaviCare enrollment applications to meet monthly enrollment goals. Explains the NaviCare program clearly and consistently to prospects and their families to ensure that prospects enroll with a solid understanding of the program maintaining a low disenrollment rate. Meets with NaviCare prospects in their homes. Completes application and other documentation needed. Submits all completed applications in a timely manner as required by CMS. Tracking & Reporting Documents all sales activities in the department’s CRM application and account management grid in a timely manner. Meets weekly sales activity deliverables consistently, and tracks these in the CRM and their Outlook calendar. Maintains records of NaviCare applications and documentation related to scope of appointments. Assessment Regularly reviews effectiveness of efforts against goals. Provides market intelligence to the NaviCare/ Manager and the Outreach Director so that adjustments can be made to tactical plans. Manages their own professional development by seeking advice, training, and coaching from their colleagues, manager, and the Director of Outreach. Regulatory Guidelines Operates within the marketing and outreach guidelines and regulations provided by CMS and EOHHS.. Retains Scope of Appointment and other Enrollment Records. Submits information on NaviCare prospect events to Outreach Support in a timely manner, for CMS submission. Qualifications Education : BS or BA degree and/or comparable experience License: Valid Massachusetts Driver’s License Certification: AHIP ( can obtain after hire) Experience: Knowledge and experience working with community organizations, low income communities and the elderly 3 years of sales experience in healthcare or group insurance strongly preferred. Must have proven experience working in a customer facing role focused on sales, lead generation in a high paced customer service or sales environment. Knowledge of Medicare, Medicaid and insurance products is desirable. Knowledge of customer service, sales, outreach and marketing principles and practices. Possession of a valid Mass. driver’s license and a vehicle to be used for marketing activities and home visits. PI119473190

Who we are: Notre Dame Health Care Center, Inc. deeply rooted in the heritage of the Sisters of Notre Dame de Namur, is committed to the physical, spiritual, and emotional care of our residents and patients. Located off the shores of Lake Qunsigamond within the woods of the Worcester Land Trust, our du Lac assisting living seeks RNs and LPNs committed to providing only the highest level of care to our residents. In exchange, NDHC is committed to providing our staff with a respectful, professional, and safe workplace. Duties include assisting with service plan development, supervising staff, assisting with scheduling, oversight of resident services and appropriately dealing with emergency situations when they arise. The management scope includes direct supervision of Resident Care Associates as well as monitoring emerging health needs of residents, covering for resident care staffing as needed and assisting the Resident Care Director with on-call duties. The Wellness Nurse will follow up on family issues as directed by Resident Care Director. PM17 Current LPN / RN in the state of Massachusetts Strong communication skills, flexibility and ability to multitask Assisted Living experience required Weekend availability PI119105768

Call Center Openings! Great Training and Career Path! $17.50/hr! US-MA-Worcester Job ID: 5950 Type: Full Time # of Openings: 1 Category: Customer Service Fallon Health Overview Fantastic Call Center & Advancement Opportunities in Health Care! The Opportunity: We are currently hiring for a 9:30 am - 6:00 pm shift with one evening per month and occasional weekends between October - March. It’s an exciting time to join Fallon Health as we experience growth and expansion with new services and products. There are many great opportunities within our organization starting with joining our Member Services team. Member Services offers a very unique opportunity to interact with nearly every facet of the FCHP organization including our products, services, functions, and people. Among the most rewarding and fulfilling parts of working on this team is representing Fallon Health as the face of the organization; the single point of contact for our valued providers and members. Think of yourself as an FCHP brand and membership ambassador. As a representative of Fallon Health, you will be an advocate to members reaching out for support; providing this highly valued service fielding calls and consultatively troubleshooting inquiries, you will be solving their needs and concerns. In addition to the diverse responsibilities outlined below, a spot on this team also represents one of the best places to grow your career. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions and endless opportunities for advancement. Member Services has proven to be a launching pad of development that has translated into long term careers with advancement opportunities throughout the company in a number of different key area’s such as; Sales and Marketing, Provider Relations, Care Services, Pharmacy and other functions of the operation. As a brand champion and valued member ambassador you will get extensive training and support through a skill based progression training program that includes a blended learning curriculum and personalized coaching plan. We are always looking for top talent in these roles so feel free to pass this along to friends, family and colleagues that you think qualify. Responsibilities Position Overview: The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health's 1-800 numbers, as well as providing direction on Plan policies, procedures, and benefits. Some key responsibilities include: Ownership for development of knowledge and skills, as training program provides material and framework for success. Ownership for customer satisfaction. Member Service Representatives are the primary liaison for our members to obtain the information or support they need As such, our representatives are expected to fully understand member/ provider needs, and within corporate/ department policies, take whatever action is necessary to fully satisfy the inquiry. Clear and concise documentation of call detail for tracking of member/ provider contacts. Identification and communication of trends that are indicative of enterprise service issues. Escalation of member/provider concerns and servicing issues. Appropriate execution of corporate and department policies/ practices. Qualifications High school diploma required, Bachelor’s degree or advanced education desirable 2+ years professional work experience preferably in a customer facing inbound call-center setting. The ability to multitask and leverage strong typing skills and a high proficiency with MS Word, MS Excel and system data entry are essential tools for success in this role 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 the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org PM16 PI118962087

Healthcare Analyst - CMS & Star Rating Experience -SQL - Growing Healthcare Organization US-MA-Worcester Job ID: 5944 Type: Full Time # of Openings: 1 Category: Data Management/Reporting Fallon Health - Corp HQ 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. Brief Summary of Purpose: Principle responsibility of the Operation Support Services Star Analyst IV is to collaborate with Fallon Health’s 5 Star owner to produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual measure and interventions performance. Dashboard reports are based on real time cross sectional segments. This includes working with business areas to design, develop, modify and test reports to support business needs and transaction management in support of Fallon’s 5 star rating goals. The analyst will leverage their developer skill set and experience with large health care data sets and relational databases to develop complex reporting solutions. The objective of the Analyst IV activities is to attain efficiencies and effectiveness when capturing work outputs and transactional history into manageable data segments with actionable activities.. It is also expected that this analyst p roactively identifies and addresses scalability and performance bottlenecks to support efficiencies. They are consultative to the business and accountable for the quality and effectiveness of the data in the subject area across all related systems (QNXT, data warehouse) and are expected to be subject matter experts for this data. Responsibilities Produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual measure and interventions performance. Dashboard reports are based on real time cross sectional segments. Analyzes and supports data analytics to easily identify Medicare Star measures for cultural trends (demographics, disparities and social determinants), operational inefficiencies and provider practice patterns Reviews current reports and outputs for accuracy, efficiency and viability Gathers business requirements; determines most effective and efficient reporting platform Review logic, criteria and definitions to incorporate into data models to extract functional data sets for reporting Develops outputs based on gathered requirements Performs testing and re-engineering Develops alternative techniques for gathering a variety of data that is not available from established sources Assist in the identification of trends that impacts 5 Star ratings Leverages mathematical calculations to determine integrity of data samples Evaluates risks; collects statistical information to determine whether business areas have negative impacts on their businesses, or at least improve their business practices, Consultative to business owners to applying analytical findings to the business. Actively participate in analyst meetings Identifies improvements regarding report efficiencies and platform effectiveness Works with business owners to research root cause and communicate improvement recommendations Participates in continuing education activities to improve upon skills Support design and execution of analytical roadmap in collaboration with organizational 5 star owner and domain experts to drive delivery of analytical projects that support relevant, actionable business insights. Work collaboratively with Director and business owners Provides assistance on technical matters and act as a significant information resource Participant in cross functional initiatives Qualifications Bachelor Degree or advanced education preferably in Business Administration or Computer Science Proficient in T- SQL, VB, MS Visio and MS office including Access, Word, Excel & Power point. Must have proven ability to perform advanced programming, program design and use of tables, queries, forms and macros. Business analysis experience on at least 5 major enterprise projects. 5+ years’ experience in data analysis. Excellent interpersonal, verbal and written communications skills. Ability to facilitate meetings and requirement sessions. 3+ years of experience with CMS Star ratings a big plus! experience with quality or other comparable data reporting experience required. 5+ years’ experience in managed care industry is required. JT18 PI119415854

REGISTERED NURSE - RN - GROUP HOME CareerStaff Unlimited is looking to hire a Registered Nurse for a contract opportunity in WORCESTER, MA . Qualified nurses will have previous pediatric/adolescent experience and have a strong focus on patient care. This role consists of medication management, proper documentation, contacting prescribers to confirm med orders, and client education of medication effects. This opportunity has the possibility to become a permanent placement for the right candidate. If you are passionate about working with patients and making a difference in their lives, this position will be a great match for you! Contact me today to learn more about this opportunity! BENEFITS OF CAREERSTAFF UNLIMITED SERVICES: Competitive Compensation Package Weekly & Daily Pay with Direct Deposit Immediate Openings Flexible Schedules Referral Bonuses Our strong, long-term connections-with the most admired companies-mean a new world of possibilities for your career. Partnering with CareerStaff Unlimited is the kind of proactive move that can put you on an inside track, give you access to more career opportunities, and get you that dream job faster than going at it alone. JOB REQUIREMENTS - REGISTERED NURSE RN: 6 months of pediatric experience 1 year of nursing experience Active CPR/BLS certification Must be eligible to work in the United States Active Massachusetts RN license ABOUT CAREERSTAFF UNLIMITED: CareerStaff Unlimited, LLC ("CareerStaff") is a leader in the delivery of workforce solutions and staffing services for the healthcare industry. Our mission is to connect our clients with talented healthcare professionals ensuring the delivery of exceptional patient care. We serve our mission by leveraging a national network of 25+ offices throughout the United States. CareerStaff's services include travel and per diem employment opportunities for nurses, therapists, and pharmacists. Additionally, CareerStaff provides Managed Service Programs to hundreds of healthcare facilities nationally. By offering unparalleled customer service, unique placement opportunities, top pay and benefits, and employment that meets the lifestyle requirements of our clinicians, CareerStaff attracts high-quality clinicians who transition well to new environments and rapidly assimilate into facility teams. CareerStaff Unlimited is proud to practice Equal Employment Opportunity and Affirmative Action (EEO/AA). PI119486925

P&C Account Representative Now hiring - Full and Part time roles available SterlingBridge, headquartered in downtown Worcester, MA is is seeking a highly motivated individual with a comprehensive background in commercial and personal lines insurance to join our growing team. In this position you will be responsible for day-to-day servicing and selling of Commercial Lines accounts in our P&C department centrally located in Worcester, MA. If you have worked for an insurance company, or an agency, this may be the right fit for you! Responsibilities: Provide a high level of customer service and sales/marketing expertise in commercial lines business while fostering and maintaining ongoing customer relationships. Address client inquiries based on product knowledge and sound business decisions. Ensure timely, organized and efficient sales and service results. The successful candidate will have the following: Current P&C license Prior Agency Customer Service/Sales experience within Commercial Lines and Personal Lines Must be proficient in all lines of business-including coverage, underwriting & rating Excellent written & verbal communication skills Ability to understand insurance product contract language Ability to work independently Strong organizational, & computer skills Possess a strong sales acumen Knowledge of AMS system or comparable CRM system a plus SBIA has been a full-service insurance agency since 1979, offering a diverse portfolio of insurance products customized to meet the needs of thousands throughout the United States. At SBIA, our mission is to help employers and individuals navigate the maze of insurance purchasing decisions and stand with them to monitor and adjust their strategies to retain employees and pursue their financial goals. Join our premiere national insurance agency as we grow! PM17 PI119400329

Trainer - Operating Support Services - Growing Healthcare Organization US-MA-Worcester Job ID: 5945 Type: Full Time # of Openings: 1 Category: Other Fallon Health - Corp HQ 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. Brief summary of purpose: In collaboration with business owners, provide training approach, design , develop and deliver blended (virtual, self-paced and classroom) course material using proven instructional design methodologies to multiple delivery channels.Iin addition to administrative and technical training support for assigned areas. Position includes a high degree of training to technical and non-technical staff of business requirements, process and service oriented responsibilities. Provide information on employee training and performance to senior management; Responsibilities Proactively research training content with Subject Matter Experts through interview techniques, review of existing documentation and job shadowing. Partner with subject matter experts on e-Learning and instructor training materials In collaboration with business partners, determine the audience, training needs and platform for training delivery. Includes ad hoc or scheduled instructor led programs in addition to eLearning solutions. Develop training materials including documentation, job aids PowerPoint presentations, quizzes and web based materials as needed. Convert existing trainings to web-based classes, including quizzes and other interactions as needed, and to create new trainings designed to be delivered electronically (either through the LMS or webinar). Work with department managers to identify mandatory trainings for new/existing employees, and create learning plans to capture and track these trainings within an assigned time frame. Deliver selected trainings in-person or virtually Provide day-to-day technical support to all end users of the Learning and Talent Management Systems, Adobe Connect, and other related products. Manage user access to web-based events, acting as first-line technical support to attendees. Ensure required training is assigned via the LMS and results are communicated to managers and senior leadership Coordinate procedural based training within the LMS Establish and maintain reporting process to ensure accuracy of data and metrics Organize all course content. for employee and contractor use, ensuring alignment with company needs and initiatives Maintain and update training attendee database. Establish and document LMS and training program-related processes, procedures, and supporting documentation. Assist with reporting per direction of the trainer and/or department head Anticipate and plan for future training events and make course corrections necessary in advance of the events. Provide continuous system evaluations for improvement potential and work with vendors to implement system improvements and updates. Identify, train, and oversee Super Users of Learning and Talent Management systems Coordination of training program schedule of classes, webinars, etc., including facilities allocation, materials, and pre-post-work communication. Give support and resolution of help requests and trouble shoot issues. Communicate effectively with employees and trainer by phone, in person, or through electronic correspondence. Qualifications Bachelor's degree or equivalent experience in related field 2+ years’ experience as designing and developing blended (virtual, self-paced and classroom) course material using proven instructional design methodologies to multiple delivery channels and leading and facilitating adult training experiences required, ideally in a health care setting. Proficiency in learning management systems. including but not limited to Power Point, Webinar, Learning Management and Employee Performance Management Systems and other methods as appropriate to develop and administer the technologies Experience in curriculum design and presentation Experience communicating with technical and non-technical stakeholders across Fallon Health Proficiency in MS Office Suite Expert level knowledge of and experience with learning management systems (LMS) and talent management system required Knowledge of instructional design Ability to run reports, edit documents and analyze data Knowledge of relational database applications Strong project and process management skills Analytical and problem-solving skills Excellent interpersonal, verbal, and written communication skills Ability to work independently as well as part of a multi-disciplinary team. Sharepoint PM16 PI118927361

Member Appeals & Grievances - Growing Health Care Org! US-MA-Worcester Job ID: 5873 Type: Full Time # of Openings: 1 Category: Customer Service Fallon Health - Corp HQ 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 www.fallonhealth.org . Position Overview: The Fallon Health Appeals and Grievance process is an essential function to Fallon Health’s compliance with CMS regulations, NCQA standards, other applicable regulatory requirements and member expectations. The Fallon Health Member Appeals & Grievances Coordinator serves to administrate the Fallon Health Appeals and Grievance process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between Fallon Health members and Fallon Health with their complaints regarding denied claims, referrals, membership and benefit issues and any grievances regarding quality of care or service. The Member Appeals & Grievances Coordinator is responsible for presentation of the member appeal to the Plan Medical Director, Center for Medicare/Medicaid Services, contracted reviewer, and the Plan contracted external review agency in accordance with applicable laws, organization policies, and regulatory requirements. Thorough research, documentation, and corrective action planning must be established for each respective case and effectuation completed in accordance with existing regulations, policies and standards. Responsibilities Administrate FCHP Standard and Expedited Appeals Processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable NCQA standards and other state or federal regulatory requirements. Strict adherence to department turn-around time standards established in accordance with regulatory standards is required Act as the primary investigator and contact person for member grievances and appeals, which includes sending the appropriate acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant information from the member regarding the grievance/appeal, notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue. Conduct non-biased, accurate, timely and comprehensive investigation of all facts related to the grievance/appeal. Thoroughly document all action taken on behalf of the member to resolve the grievance/appeal Ensure that all grievances/appeals are processed in adherence to state and federal regulations (i.e. CMS, MassHealth, OPP), contractual obligations, NCQA guidelines and Plan policy. Ability to interpret and operationalize multiple products and regulatory requirements and differences in each. Ability to multitask and respond quickly and accurately to issues and concerns for members and internal departments. Research, investigate and document all plans for corrective action. On-call approximately one holiday (3-day) weekend per year and one 2-day weekend every 5 weeks and as needed. Available by cell phone to accept new expedited appeal requests and, where necessary, to present to the FCHP office to process request within applicable turn-around time standard. Special projects as assigned by Management. Conduct case management of legal/risk issues regarding member complaints, weighing interests of all customers, both internal and external Adhering to FCHP confidentiality policy; document, research and review member complaints, involving quality of care or quality of service with appropriate clinical and/or administrative staff. Work with Team Leaders, Department Managers, Department Chairs and/or Medical Director to resolve member complaints; formulate improvement measures and response to member; prepare written correspondence to member. Forward all documentation involving member quality of care or quality of service complaints to FCHP administration and FCHP Quality Management Department. Adhere to department standards for completion of member complaints. Research and resolve system-wide issues, deficiencies, problems and formulate quality improvement measures. Qualifications Education: College degree (B.S. or B.A.) or equivalent Experience: 1-3 years previous professional experience in related position (preferably in health care) PI118962086

Description: A Top Rated Non-Profit Facility Excellent Staffing Ratios Excellent Benefits Weekly Payroll Who We Are: Notre Dame Health Care Center, deeply rooted in the heritage the Sisters of Notre Dame de Namur, is committed to the physical, spiritual, and emotional care of our residents. Located off the shores of Lake Quinsigamond within the woods of the Worcester Land Trust, we seek candidates committed to providing high quality and compassionate care to our residents within our skilled nursing facility. Certified Nursing Assistant (CNA) Job Responsibilities: Under the direction of the Charge Nurse, C.N.A. provides for the care of residents within scope of training, assigned duties, and within scope of NDHC policies and procedures. Responsibilities include, but are not limited to, the following: Performs all personal care activities under the direction of an RN and which may include, but not be limited to, assisting the patient or client with personal hygiene, ambulation, eating, dressing, shaving, and physical transfer, Ensure resident care environment is appropriately maintained to reflect a clean, safe and healthy environment, Assist with tasks associated position including, but not limited to, all aspects of resident assistance, transporting, and ADL care, Assist resident/staff with the use of devices such as a wheelchair, walker, and mechanical lift devices, Assisting with prescribed range of motion exercises, Keeping records of personal health care activities, Preparing and assisting residents with meals, Assist residents/staff with daily activities and social programs, Observing appearance and gross behavioral changes in the patient and reporting to the RN. PM17 .Requirements: MA C.N.A. Certification required. Must be able to work every other weekend and every other holiday. Must be able to work all scheduled hours regardless of bad weather. Position requires flexibility in daily schedule to accommodate needs of residents. 1-3 years experience as a C.N.A. preferred, but not required. PI119105760

We are currently searching for a talented professional for the position of Awake Overnight Residential Counselor at the Wetzel Center (Latency Unit). The scheduled hours for this position are Wednesday - Saturday 10pm - 8am. This position does require holiday coverage when the holiday falls on a scheduled shift. Training will be provided to selected candidates as required by the position. Responsibilities: Provide quality clinical and residential services within the therapeutic milieu. Remain awake and alert throughout the shift. Provide crisis management. Responsible for ongoing safety and supervision of youth within the program setting. Responsible for maintenance and implementation of program policies and program development. Qualifications: High school diploma or HiSET required. BA/BS in Social Work, Psychology, Sociology, Human Services, or related field is preferred. Experience working with children and/or adolescents preferred. Candidates must possess a valid driver’s license as required by the position. This position is responsible for transporting our youth for recreation and safety purposes. PM19 PI119193427

SterlingBridge is looking for a Health Insurance Broker Service Representative - Customer Service Representative - Administrative Support to work with our external brokers and their clients, promote health insurance sales, and assist in marketing to our broker community. This position requires top notch customer service skills, in depth knowledge of health insurance products, and an ability to problem solve during case management and submission. This is an internal position with potential for growth as an insurance agent. Health Insurance Broker Service Representative Position Responsibilities Establish, develop and maintain broker relationships with current and prospective health insurance brokers Fielding inbound broker and customer support calls/emails Maintain understanding of offered health, dental, and other ancillary products including eligibility, reporting rules, and online shopping Participate in broker webinars and seminars Consult with broker customers regarding health insurance options during open enrollment Qualifications/Education/Experience/Skills/Abilities Must have and be able to maintain a MA resident state health insurance license 2 year college degree or equivalent, and/or 2+ years experience in sales or service, preferably in a health insurance or carrier/agency setting Strong customer and interpersonal skills, including written and verbal communication and phone presentation Experience with a CRM a plus; preferably Microsoft Dynamics CRM About SterlingBridge At SterlingBridge, we recruit individuals who fit our culture and values. The atmosphere is fun, friendly but with a high degree of professionalism. We respect our colleagues, customers and business partners. It is a challenging, dynamic and energized environment, with opportunities for personal and professional growth. If you are open-minded, driven and quick to learn we want to speak to you. SterlingBridge has more than a half-century of insurance industry know- how, insurtech leadership , and a "We're On It" spirit . We understand insurance agents, customers, and the tools they need to thrive. SterlingBridge offers a friendly environment and competitive salary in addition to the following benefits: Generous Paid Time Off, Health & Dental Insurance, Life Insurance, Short & Long Term Disability, Garage Parking, Matching 401(k), Pre-tax Medical & Dependent Care Reimbursement, Insurance licensing continuing education opportunities and free employee networking events. PM17 PI119400325

The Village STARR program in Worcester, MA is currently seeking a talented and energetic Clinical Coordinator to join our team! The Clinical Coordinator will be responsible for overseeing, coordinating, and managing the clinical practice and case management of the STARR program. To that end the clinical coordinator may act as a liaison between the agency and external entities involved the specific service area. The clinical coordinator will oversee the performance of direct care clinical staff, counseling staff and/or casework staff in that specialty area. The Clinical Coordinator will be responsible for understanding the clinical specialty area and will ensure that services are delivered in compliance with best practice standards, contracting and regulatory entities’ performance specifications, agency policies, procedures and regulations. If appropriate, the clinical coordinator will ensure that his/her supervisees provide high-quality clinical care in keeping with best practices and that those supervisees attend to risk issues, documentation of care, timeliness of documentation, professionalism, productivity, and administrative issues related to providing clinical care. The Clinical Coordinator will also provide direct services to clients at an established productivity proportionate to other responsibilities. Qualifications: Demonstrated strong knowledge of child/youth and family clinical care and support, as well as mental health, educational, child development, child welfare, community outreach, and juvenile justice systems. Proof of a valid driver’s license, acceptable driving record, and reliable personal transportation to fulfill essential job functions is required. Privately owned vehicle has current and valid state registration and safety inspection sticker, is safe, and is ensured according to the minimum state requirements (pertaining to bodily injury and liability). Demonstrated knowledge and competency with direct psychotherapeutic clinical care, including risk assessment, safety planning, general comprehensive assessment, treatment planning, service delivery, and discharge/after-care planning. Ability to ensure that clinical care meets medical necessity and that service delivery meets all compliance standards. Knowledgeable of program specifications (BSAS, CBHI, DCF, DPH, DYS, and EEC), regulatory requirements, licensing requirements, credentialing requirements, HIPAA, and other laws and regulations related to clinical care. Demonstrated strong ability to exercise discretion, confidentiality, collaboration, and independent judgment. Demonstrated excellent oral and written communication skills, organization skills, timeliness, reliability, problem-solving, and ability to work collaboratively and effectively with others. Education, Clinical Licensure, and/or Experience Master’s or Doctoral Degree in Psychology, Social Work, Marriage and Family Therapy, Mental Health Counseling, or related field required. Independent clinical license required (unless otherwise indicated by regulatory entity). Minimum of two years clinical experience (unless otherwise indicated by regulatory entity) in behavioral health setting, preferably working with child, adolescent, and family services. Familiarity with Electronic Health/Billing Record required. Bilingual (Spanish/English) capabilities preferred. Physical Demands: Must be able to perform sedentary aspects of position, including, but not limited to desk and electronic work, typing, driving to meetings and trainings, as well as driving/transporting clients as necessary. Must be able to perform the duties listed above, with or without a reasonable accommodation Employee may be required to intervene in order to de-escalate and/or provide safety and if essential, provide physical management of clients, using methods and techniques approved by Y.O.U., Inc and appropriate to ambulatory and home-based settings. Employee needs to complete the agency’s human service worker safety and/or home-based worker safety training. PM19 PI119193428

About The Community Builders, Inc. Join a growing organization that is strengthening neighborhoods across the nation! The Community Builders, Inc. (TCB) is one of America's leading nonprofit real estate developers and owners. Our mission is to build and sustain strong communities where people of all incomes can achieve their full potential. Position Description: The Resident Specialist will have responsibility for providing a superior level of customer service to the residents, guests and team members at the property site. This role is responsible for showing and leasing apartments, assisting in the moving process and providing administrative support to the Community and/or Services Maintenance Manager for a variety of property related tasks. She/he will adhere to the companys Mission Statement and ensure the site is in compliance with all regulatory requirements. Candidates with experience in Section 8 housing and LIHTC are preferred. Essential Functions: Answer or return all calls promptly and with the highest level of customer service. Schedule appointments and conduct in-person visits as needed. Listen to resident requests, concerns and comments, refer them as appropriate. Develop relationships with residents to understand their needs and aspirations and develop trust. Initiate Maintenance Service Requests promptly and follow up with residents to ensure completion of service. Greet prospective tenants and show the property and its features in accordance with established procedures. Process applications for approval and follow up with applicants. Pre-qualify prospects in accordance with the company procedures and housing requirements Conduct service inspections with the Service Management team to ensure apts. are in move-in condition. Facilitate and attend community engagement activities with residents, as directed by the Community Manager. Manage rental payment process. Prepare recertification and lease renewals, and enter data into tracking system. Other Responsibilities: Contribute to cleanliness and curb appeal of the community on continuing basis. Conduct market surveys and shop competitive communities. General clerical duties: photocopying, faxing, mailing and filing, sign for and distribute packages. Track and ensure timely delivery of resident notices. Coordinate and maintain records for staff office, phones, parking and office keys. Code and process invoices and research discrepancies as needed. Knowledge, Skills and Abilities: Excellent Customer Service, verbal and written communication (English language) skills Ability to type at least 35 wpm Demonstrated ability to learn and operate office systems including telephone, copier and computer systems. Proficiency with Microsoft Office including Word, Excel and MS Outlook Education & Experience: High school graduate or GED equivalent Customer service experience in Property/Hotel/Retail, Sales 1+ year Experience and proficiency of Microsoft Office Industry software such as Yardi a plus The Community Builders, Inc. is committed to ensuring diversity in its workplace, and candidates from diverse backgrounds are strongly encouraged to apply. PI119195739

Who we are: Notre Dame Health Care Center, Inc is deeply rooted in the heritage of the Sisters of Notre Dame de Namur, is committeed to the physical, spiritual, and emotional care of our residents and patients located off the shores of Lake Quinsigamond within the woods of the Worcester Land Trust, our top rated Assisted Living provides high quality compassionate care to the Central, MA community for over 20 years. NDHCC is seeking an experience Dining Room Supervisor Full-Time to assists in the management & operations of the Food & Beverage Department, focusing on the importance of first class dining experience for our residents. Responsibilities: Training the dining staff and assists with hiring new dining staff Creates and manages the servers schedule Organized and executes banquet events Maintains safety and cleanliness standards in dining areas according to community standards and state regulations Other duties may apply PM17 Minimum 2 years experience of serving/hosting experience preferred. Exceptional customer service skills. Flexibility in scheduling, including weekends and holidays. Excellent verbal and written comminications skills. High school diploma or equivalent. Associate degree or higher in the hospitality field preferred. PI119105758

SterlingBridge, headquartered in downtown Worcester, MA is seeking a candidate to join a growing insurance agency. This entry level role provides a career path in the insurance and financial services industry and is perfect for a recent graduate or someone looking to enter this dynamic profession. No experience? No problem ~ We will train you! The ideal candidate will have a college degree, computer skills, phone/customer service expertise, and a willingness to learn. There are various opportunities available in our Insurance Agency, where you will speak with potential customers regarding insurance coverage on behalf of the insurance providers in the region. In addition to the training provided, we will provide the support and resources you’ll need to obtain your Massachusetts Life, Accident & Health license. Advancement awaits you! At SterlingBridge, we recruit individuals who fit our culture and values. The atmosphere is fun, friendly but with a high degree of professionalism. We respect our colleagues, customers and business partners. It is a challenging, dynamic and energized environment, with opportunities for personal and professional growth. If you are open-minded, driven and quick to learn we want to speak to you. SterlingBridge has more than a half-century of insurance industry know- how, insurtech leadership, and a "We're On It" spirit. We understand insurance agents, customers, and the tools they need to thrive. SterlingBridge offers a friendly environment and competitive salary in addition to the following benefits: Generous Paid Time Off, Health & Dental Insurance, Life Insurance, Short & Long Term Disability, Garage Parking, Matching 401(k), Pre-tax Medical & Dependent Care Reimbursement, Insurance licensing continuing education opportunities and free employee networking events. PM17 PI119400331

Clinical Documentation Improvement Specialist US-MA-Worcester Job ID: 5868 Type: Full Time # of Openings: 1 Category: Other Fallon Health - Corp HQ 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. Brief Summary of Purpose : Responsible for the overall improvement of the quality, completeness and accuracy of medical record documentation through interaction with physicians and other business partners. Ensures clinical documentation reflects the level of service, severity of illness, risk of mortality is complete, accurate and successfully facilitates the accurate representation of a patient’s medical records that translates into coded data. Responsibilities Able to collaborate extensively with physicians, nurses, other caregivers, and medical records coding staff to improve quality and completeness of documentation of care provided and coded Assist in the collection and analysis of risk adjustment data in-order to identify documentation, coding trends and opportunities Audit medical records for accuracy of coding, ambiguous, conflicting or incomplete documentation. Conducts concurrent review of the medical records to increase the accuracy, clarity and specificity of provider documentation. Provide feedback to providers and external/internal business partners of audit findings and make recommendations as necessary. Keeps current with changes in coding guidelines, compliance, reimbursement, and other relevant regulatory updates Develop and coordinate education and training that focuses on Risk Adjustment coding and documentation opportunities utilizing a variety of methods to deliver content, such as direct provider collaboration, power point presentations, teleconferences and webinars. Partner with key business areas around provider education, engagement and develop follow up plans where appropriate. Collaborate with internal business partners to achieve department objectives and ensure internal risk adjustment compliance and standards are maintained Assumes responsibility for professional development by participating in workshops, conferences and/ or in-services. May be called on to present to large and/or small groups of executives, physicians and other clinical or financial personnel Assist with coding chart review projects and RADV audits May be required to Audit vendors and internal coders work Qualifications Education Minimum of Bachelor’s degree. BSN in Nursing or related clinical experience is preferred but not required. License/Certifications Possession of AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders) of any of the following Certified Coding Specialist (CCS), Certified Risk Adjustment Coding (CRC) or Certified Professional Coder (CPC) required. RN Licensure preferred Experience Strong organizational skills in multiple settings, as well as the ability to exercise judgement and initiative Strong written, verbal and presentation skills Possess Critical Thinking skills Competent in MS Office Proven/demonstrated knowledge in the following ICD-10-CM Coding/Risk Adjustment HCC coding Regulatory Compliance HIPAA and Legal Aspects of Health Information Medical Reimbursement Methodologies Medical Terminology Self-motivation with excellent follow through skills with ability to work independently with minimal to moderate supervision with demonstrated ability to work as an effective team member Adaptive and flexible to new ideas and change Travel to provider offices Experience working and interacting with the Provider community Preferred: 2 year of Clinical Documentation Improvement (CDI) experience in the inpatient/outpatient setting Thorough knowledge of ICD-10-CM, Medicare, Medicaid, Commercial HCC coding guidelines Previous experience with Risk Adjustment coding is preferred PM16 PI118927349

SterlingBridge is looking for a Health Insurance Broker Service Representative - Customer Service Representative - Administrative Support to work with our external brokers and their clients, promote health insurance sales, and assist in marketing to our broker community. This position requires top notch customer service skills, in depth knowledge of health insurance products, and an ability to problem solve during case management and submission. This is an internal position with potential for growth as an insurance agent. Health Insurance Broker Service Representative Position Responsibilities Establish, develop and maintain broker relationships with current and prospective health insurance brokers Fielding inbound broker and customer support calls/emails Maintain understanding of offered health, dental, and other ancillary products including eligibility, reporting rules, and online shopping Participate in broker webinars and seminars Consult with broker customers regarding health insurance options during open enrollment Qualifications/Education/Experience/Skills/Abilities Must have and be able to maintain a MA resident state health insurance license 2 year college degree or equivalent, and/or 2+ years experience in sales or service, preferably in a health insurance or carrier/agency setting Strong customer and interpersonal skills, including written and verbal communication and phone presentation Experience with a CRM a plus; preferably Microsoft Dynamics CRM About SterlingBridge At SterlingBridge, we recruit individuals who fit our culture and values. The atmosphere is fun, friendly but with a high degree of professionalism. We respect our colleagues, customers and business partners. It is a challenging, dynamic and energized environment, with opportunities for personal and professional growth. If you are open-minded, driven and quick to learn we want to speak to you. SterlingBridge has more than a half-century of insurance industry know- how, insurtech leadership , and a "We're On It" spirit . We understand insurance agents, customers, and the tools they need to thrive. SterlingBridge offers a friendly environment and competitive salary in addition to the following benefits: Generous Paid Time Off, Health & Dental Insurance, Life Insurance, Short & Long Term Disability, Garage Parking, Matching 401(k), Pre-tax Medical & Dependent Care Reimbursement, Insurance licensing continuing education opportunities and free employee networking events. PM17 PI119400321

We are currently searching for a talented professional to join our Residential Services team as a Milieu Coordinator in the Worcester Area! GENERAL ACCOUNTABILITIES: The Milieu Coordinator is responsible for coordinating the day-to-day staffing, milieu routine and activities, and coaching and modeling of Residential Counselors. This role also may involve working in ratio or supervising shifts in order to achieve programmatic success. The Milieu Coordinator will work with the Program Director/Assistant Director to ensure coordination with facility manager and/or facility venders, and/or first responders, DCF, Mobile Crisis, EEC, and others as needed. When the Milieu Coordinator is supervising a shift he/she will provide supervision for residential counselors. The Milieu Coordinator is responsible for maintaining a milieu that operates efficiently, effectively, and in a strength-based and trauma informed manner. The Milieu Coordinator will be a part of a multidisciplinary team working to improve mental health functioning of youth in the program. This position will require flexibility, and will include some evening and weekends. Hours will be a variation of 10am – 7pm or 11am – 8pm. ESSENTIAL DUTIES AND RESPONSIBILITIES: Coordinate the day-to-day staffing, milieu routine and activities, and coaching and modeling of Residential Counselors. This role also may involve working in ratio or supervising shifts in order to achieve programmatic success. Work with the Program Manager/Assistant Director to hire, train, coach and model staff, and address any performance management and/or progressive discipline issues that arise. Provide direct supervision to residential counselors as appropriate to program design. Monitor issues of risk and/or potential risk, and report issues of immediate concern to the Program Director, Senior Director, VP, and the CEO if needed. Compose oneself with professionalism, ethical practice, and compassionate regard for consumers/clients. To this end, the Milieu Coordinator should demonstrate competency, reliability, honesty, integrity, respectfulness, continued learning, positivity, mutual support, effective collaboration, active listening, and attention to the responsibilities of the job. The Milieu Coordinator should dress neatly, professionally, and appropriately to the situation. The Milieu Coordinator should communicate orally with etiquette, honesty, respectfulness and composure; written communication should demonstrate excellence and be in keeping with the policies and procedures of the agency. The Milieu Coordinator will work with the Program Director/Assistant Director to ensure coordination with facility manager and/or facility venders, and/or first responders, DCF, Mobile Crisis, EEC, and others as needed. Work in an integrative, collaborative, and supportive fashion with other departments within the agency, and provides assistance as needed. QUALIFICATIONS Demonstrated knowledge of milieu programming. Demonstrated ability to exercise discretion, confidentiality, collaboration, and independent judgment. Ability to multi-task, report accurately, and be collaborative in problem solving. Ability to communicate ideas and information orally and in writing. Demonstrated administrative and organizational capabilities. Ability to build rapport and work effectively with others. Knowledgeable of program specifications per contract, regulatory requirements, licensing requirements (EEC), HIPAA, and/or other laws and regulations related to service delivery. Able to identify areas of risk and plan for safety EDUCATION and/or EXPERIENCE High School Diploma/GED/HiSet, required Bachelor’s degree in social work, counseling, psychology, human services, or related field, preferred Milieu experience with children/youth, preferred Two years of experience in direct service and supervisory experience, required Two years of experience in a residential setting working with children/adolescents, required Candidate must be at least 21 years of age Ability to use Microsoft Office Suite and electronic health record-keeping systems as necessary Bilingual (Spanish/English) capabilities, preferred A valid driver’s license, acceptable driving record to fulfill essential job functions is required, and personal transportation to fulfill essential job functions, required PHYSICAL DEMANDS Must be able to perform the duties listed above, with or without a reasonable accommodation Employee will be required to intervene in order to de-escalate and/or provide safety and if essential, provide physical management of clients, using methods and techniques approved by YOU, Inc. and appropriate to setting. Employee must complete the agency’s human service worker safety training. PM19 PI119193422

Healthcare Reporting Analyst I with SQL- Microsoft Access with VBA - Health Plan Operations Support Team - Growing Healthcare Organization US-MA-Worcester Job ID: 5566 Type: Full Time # of Openings: 1 Category: Data Management/Reporting Fallon Health - Corp HQ 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 www.fallonhealth.org. Position Overview: Entry Level Analyst Position This position is responsible for completing all departmental (internal, external and regulatory) reporting and project related tasks accurately and within all required timeframes. The incumbent must have excellent organizational skills, understand the importance of regulatory and other reporting requirements, be professional at all times, be flexible and have the ability to multi-task, and prioritize work accordingly to ensure the accuracy and integrity of operational and enterprise wide reports. Responsibilities Use SQL and Access to run queries/reports and ensure integrity of the data Execute departmental reports at the required frequency with implemented quality check workflows. This reporting includes, but not limited to, production, management, regulatory, performance guarantees etc. Analyze and review data on a regular basis to ensure compliance and consistency. Communicate data outliers to business owners, Analysts and OSS Management. Obtains peer review Complete simple ad hoc reporting/queries for as needed and coordinated with management staff Manage reinsurance process Running queries and analyze data to identify claims that meet the parameters of reinsurance contract to ensure highest level of reimbursement Submitting reports to the finance department and the reinsurance vendor Processing the reimbursements appropriately Ensure the tasks associated with the Model Audit Rule (MAR) are completed timely and accurately. Understand data sources and the data to complete the reports and analyze the data with the Management Team. Special projects as assigned Qualifications Competent in SQL, Access, Word, Excel & power point required. Ability to execute queries. Proficient competences with data accuracy, QC & data integrity required. Excellent interpersonal, verbal and written communications skills required. Microsoft Access with VBA required. PM16 PI118927347

Service Maintenance Technician II The Community Builders, Inc. (TCB ) Join a growing organization that is strengthening neighborhoods across the nation! The Community Builders, Inc. (TCB) is one of America's leading nonprofit real estate developers and owners. Our mission is to build and sustain strong communities where people of all incomes can achieve their full potential. Position Description : Under the direction of the Service Maintenance Manager, the Service Technician II is responsible for promptly responding to all work orders, turnovers and property maintenance needs, and performing repairs at the certified technician level (HVAC, plumbing, electrical, carpentry, etc.) Level II Service Technicians should have a high degree of building trades knowledge, as demonstrated by certification at a technical school, and at least 2 years of experience in a facilities technician role. The Service Technician II is vital to the successful maintenance of the property, through attention to service that affects the overall cleanliness, appearance and quality of the property and its presentation to its residents and to the community. The successful candidate must have an excellent customer service focus, and be able to work in a positive, productive relationship with the other team members, and be technically skilled to work independently. Essential Functions: Prepares and performs all necessary repairs to vacant apartments for new residents. Diagnoses problems and repairs in the areas of electrical, plumbing, carpentry and HVAC, and repairs/replaces appliances as needed. This includes but is not limited to: windows, doors, all fixtures, painting, grout and tile work, keys and locks and grounds maintenance including snow removal from walkways, parking lots and buildings. Maintains an inventory of supplies and complies with OSHA regulations Responds to all service requests and on-call emergencies in a timely and professional manner, as directed by the Community Manager or Service Manager Assists in maintaining the exterior of the property daily to provide clean and appealing curb appeal at all times. Inspect the property to insure that all is in order and Service Manager is aware of any maintenance or safety issues Timely completion of work order requests and in accordance with company policies and procedures. . Provide preventive maintenance for all buildings systems, equipment and components. Prepare vacant units to be market ready within company guidelines Be aware of all utility meter cut-offs, apartment and fixture cut-offs, sewer cleanouts. Report to immediate supervisor any problems and/or issues relating to safety or management of the property. Available for weekend work, on-call rotation and emergency service call duties. Knowledge, Skills and Abilities: Strong verbal and written communication skills required. Basic computer skills, including industry software a plus. Knowledge of Federal Fair Housing Laws & Guidelines a plus. Knowledge of all hand and power tools, cleaning supplies, and protective equipment. Valid Drivers License and reliable transportation. Strong attention to detail, organizational, time-management and problem solving skills. Superior customer service skills including the ability to manage difficult customers and/or situations. Ability to read, write, understand and communicate in English, bilingual skills a plus! Physical Demands & Work Environment : Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions . Must be able to remain in a stationary position 50 percent of the time. Occasionally ascends/descends a ladder to service the lights and ceiling fans Frequently moves equipment weighing up to 100 pounds across sites. Constantly works in outdoor weather conditions. Education & Experience: High School diploma or equivalent required. Some trade school desired or 5 years of progressive responsibility in property management, hospitality or retail experience required. Minimum of 2 years of advanced hands-on repair experience at Technician II level in one or more building trades Industry-Trade certifications/Degrees (NAHMS , CAMT, OSHA, HVAC, ETC) required The Community Builders, Inc., is committed to ensuring diversity in its workplace, and applicants from diverse backgrounds are strongly encouraged to apply. PM19 PI119195730