Notre Dame Health Care Center, Inc.
Worcester, MA, USA
Who we are: Notre Dame Health Care, the operator of a five-star rated rehab and long term care center, assisted living residence, memory care units, Medicare licensed hospice, palliative and pediatric care programs, care management program, and an educational center, all located in Worcester, MA seeks a Registered Physical Therapist to work in our Rehab Department in the Long Term Care facility. Responsibilities: Conducts an initial and on-going assessments of the patients physical, psychological and social needs Organizes and conducts physical therapy programs for the facility residents Completes and submits all necessary documentation according to company policy Demonstrates an ability to plan and provide individualized patient care utilizing professional knowledge Demonstrates good time management skills Communicates pertinent information regarding patients care and needs PM17
Sep 15, 2019
Who we are: Notre Dame Health Care, the operator of a five-star rated rehab and long term care center, assisted living residence, memory care units, Medicare licensed hospice, palliative and pediatric care programs, care management program, and an educational center, all located in Worcester, MA seeks a Registered Physical Therapist to work in our Rehab Department in the Long Term Care facility. Responsibilities: Conducts an initial and on-going assessments of the patients physical, psychological and social needs Organizes and conducts physical therapy programs for the facility residents Completes and submits all necessary documentation according to company policy Demonstrates an ability to plan and provide individualized patient care utilizing professional knowledge Demonstrates good time management skills Communicates pertinent information regarding patients care and needs PM17
Claims Processor Representative - Looking For A New Job? Apply at Fallon Health Insurance! US-MA-Worcester Job ID: 5703 Type: Full Time # of Openings: 1 Category: Claims Administration 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 Summary: The Claims Processor should have a thorough knowledge of claim entry in the core and external vendor processing systems, as well as a general knowledge of claims processing. Responsible for claims corrections involving data entry errors in the data entry vendor’s queue, processing of member reimbursement requests and Customer Service cases, triage/assignment of requests for claim review and other claims documents, as well as other claims entry and processing tasks as assigned. Ensures member and provider satisfaction by providing appropriate and timely processing of claims. Must be able to work on tasks both independently and as part of a team. Responsibilities Meets or exceeds all department standards: productivity; quality; and attendance. Responsible for claims editing on claims due to data entry errors. Processes member reimbursement requests, including Part D and other prescription reimbursements in the core and external vendor processing systems. Claims entry and processing tasks as assigned. Evaluation and resolution of Customer Service cases related to reimbursement requests. Review and validation of requests for claim review and other claims documents. Demonstrate solid judgment and discretion working with confidential information. Comply with all department and company guidelines including all applicable laws and regulations. Seeks assistance from Team Subject Matter Experts (SMEs), the Trainer and Claims Manager to ensure accuracy of adjudicating claims and to develop individual skills and grow professionally. Work with teams inside and outside the department, and external customers as needed. The above is intended to describe the general content of the requirments for the performance of the job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements . Qualifications Qualification Requirements: High school diploma, college degree preferred. Medical billing and coding or equivalent experience preferred. Experience: Minimum of 1 year health care industry experience or equivalent General knowledge of CPT, ICD-10, HCPCS coding guidelines and medical terminology preferred. General ability to perform data entry and process claims efficiently and in a quality manner. Ability to follow policy and procedural documentation Some knowledge of claim processing from all perspectives (submissions, processing, dependencies) MS Office and general PC skills. Specific competencies essential to this position: Analytical ability Gathers relevant information systematically. Considers issues or factors. Seeks input from others as appropriate. Problem solving – Solves problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Results oriented – Can be counted on to exceed goals successfully. Steadfastly pushes self for results. PM16 PI113596109
Sep 12, 2019
Claims Processor Representative - Looking For A New Job? Apply at Fallon Health Insurance! US-MA-Worcester Job ID: 5703 Type: Full Time # of Openings: 1 Category: Claims Administration 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 Summary: The Claims Processor should have a thorough knowledge of claim entry in the core and external vendor processing systems, as well as a general knowledge of claims processing. Responsible for claims corrections involving data entry errors in the data entry vendor’s queue, processing of member reimbursement requests and Customer Service cases, triage/assignment of requests for claim review and other claims documents, as well as other claims entry and processing tasks as assigned. Ensures member and provider satisfaction by providing appropriate and timely processing of claims. Must be able to work on tasks both independently and as part of a team. Responsibilities Meets or exceeds all department standards: productivity; quality; and attendance. Responsible for claims editing on claims due to data entry errors. Processes member reimbursement requests, including Part D and other prescription reimbursements in the core and external vendor processing systems. Claims entry and processing tasks as assigned. Evaluation and resolution of Customer Service cases related to reimbursement requests. Review and validation of requests for claim review and other claims documents. Demonstrate solid judgment and discretion working with confidential information. Comply with all department and company guidelines including all applicable laws and regulations. Seeks assistance from Team Subject Matter Experts (SMEs), the Trainer and Claims Manager to ensure accuracy of adjudicating claims and to develop individual skills and grow professionally. Work with teams inside and outside the department, and external customers as needed. The above is intended to describe the general content of the requirments for the performance of the job. It is not to be construed as an exhaustive statement of duties, responsibilities or requirements . Qualifications Qualification Requirements: High school diploma, college degree preferred. Medical billing and coding or equivalent experience preferred. Experience: Minimum of 1 year health care industry experience or equivalent General knowledge of CPT, ICD-10, HCPCS coding guidelines and medical terminology preferred. General ability to perform data entry and process claims efficiently and in a quality manner. Ability to follow policy and procedural documentation Some knowledge of claim processing from all perspectives (submissions, processing, dependencies) MS Office and general PC skills. Specific competencies essential to this position: Analytical ability Gathers relevant information systematically. Considers issues or factors. Seeks input from others as appropriate. Problem solving – Solves problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Results oriented – Can be counted on to exceed goals successfully. Steadfastly pushes self for results. PM16 PI113596109
Inbound-Outbound Sales Rep. Medicare. Looking for a great career? Apply at Fallon Health! US-MA-Worcester Job ID: 5671 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 . Brief Summary of Purpose Ensure maximum individual and team sales productivity and effectiveness through telephone sales via both outbound and inbound call resolution. Provide company and product information, generate sales quotes, resolve non-complex service issues and close sales. Assist with the day to day operations of the call center, attend field events as needed, and the monitoring and training of telephone sales representatives. Act as a mentor to members of the inside sales team. Strong knowledge of all FCHP consumer sales products Responsibilities Responsibilities Field inbound calls from prospects interested in FCHP Medicare products. Prospects include individuals, seniors, employers, and brokers. Demonstrate consultative approach to telephone sales. Appropriately document all sales/service activity in appropriate data base (Customer Service Database, Avenue,). Conduct outbound sales calls to follow up on leads, quotes and other sales opportunities. Maintain working knowledge of competitor benefit information, health care industry trends, and health care reform activities. Maintain knowledge of FCHP product, plan features and options for all consumer products including Sr. Plan, Commercial coverage, Commonweatlh Care and Mass Health. Demonstrate strong customer service skills and willingness to “own” a prospect from start to finish. Handle calls in a courteous, respectful and helpful manner. Adhere to regulatory guidlelines re: Medicare, HIPPA, and FCHP patient confidentiality. Generate written correspondance and sales packets for prospects as requested. Maintain a personal touch in all correspondance and communication with prospects. Ability to support outside sales representatives at offsite events. Duties include presentations, staffing health fairs and one on one visits. Work very closely with team members to solve customer problem. Offers solutions and suggestions for process and product improvement to management. Perform presentations for walk-ins for any consumer health products. Field inbound calls from Broker and strategic partner for any FCHP Medicare products questions. Understand and explain Fallon Health financial arrangements and underwriting methodology. Responsible for meeting projected membership goals. Determine, understand and meet prospect needs. Assist in training activities as needed. Comply with Corporate, CMS and department policies and procedures. Qualifications Qualifications requirements Education 4 year degree preferred or equivalent in education and experience License/Certifications Massachusetts Health insurance license or ability to obtain license within 6 months of obtaining position After completion of the orientation period, and on an annual basis thereafter, required to pass a product certification exam Massachusetts Driver's License Experience Minimum of 3 years in sales or service environment. Strong knowledge of Microsoft Word, PowerPoint, and Excel 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 PM16 PI113596111
Sep 12, 2019
Inbound-Outbound Sales Rep. Medicare. Looking for a great career? Apply at Fallon Health! US-MA-Worcester Job ID: 5671 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 . Brief Summary of Purpose Ensure maximum individual and team sales productivity and effectiveness through telephone sales via both outbound and inbound call resolution. Provide company and product information, generate sales quotes, resolve non-complex service issues and close sales. Assist with the day to day operations of the call center, attend field events as needed, and the monitoring and training of telephone sales representatives. Act as a mentor to members of the inside sales team. Strong knowledge of all FCHP consumer sales products Responsibilities Responsibilities Field inbound calls from prospects interested in FCHP Medicare products. Prospects include individuals, seniors, employers, and brokers. Demonstrate consultative approach to telephone sales. Appropriately document all sales/service activity in appropriate data base (Customer Service Database, Avenue,). Conduct outbound sales calls to follow up on leads, quotes and other sales opportunities. Maintain working knowledge of competitor benefit information, health care industry trends, and health care reform activities. Maintain knowledge of FCHP product, plan features and options for all consumer products including Sr. Plan, Commercial coverage, Commonweatlh Care and Mass Health. Demonstrate strong customer service skills and willingness to “own” a prospect from start to finish. Handle calls in a courteous, respectful and helpful manner. Adhere to regulatory guidlelines re: Medicare, HIPPA, and FCHP patient confidentiality. Generate written correspondance and sales packets for prospects as requested. Maintain a personal touch in all correspondance and communication with prospects. Ability to support outside sales representatives at offsite events. Duties include presentations, staffing health fairs and one on one visits. Work very closely with team members to solve customer problem. Offers solutions and suggestions for process and product improvement to management. Perform presentations for walk-ins for any consumer health products. Field inbound calls from Broker and strategic partner for any FCHP Medicare products questions. Understand and explain Fallon Health financial arrangements and underwriting methodology. Responsible for meeting projected membership goals. Determine, understand and meet prospect needs. Assist in training activities as needed. Comply with Corporate, CMS and department policies and procedures. Qualifications Qualifications requirements Education 4 year degree preferred or equivalent in education and experience License/Certifications Massachusetts Health insurance license or ability to obtain license within 6 months of obtaining position After completion of the orientation period, and on an annual basis thereafter, required to pass a product certification exam Massachusetts Driver's License Experience Minimum of 3 years in sales or service environment. Strong knowledge of Microsoft Word, PowerPoint, and Excel 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 PM16 PI113596111
Nurse Case Manager - New Role ACO - Multiple openings - Tell a Friend - Growing Healthcare Organization US-MA-Worcester Job ID: 5728 Type: Full Time # of Openings: 1 Category: Nursing 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. Calling all RN Nurse Case Managers! It’s a very exciting time to join Fallon Health in these brand new roles supporting our growth in our MassHealth ACO (Accountable Care Organization) partnerships! We have many needs so bring along your RN friends and colleagues ! In 2018, 18 health care organizations across the state were selected to participate in MassHealth’s ACO program. This involves networks of physicians, hospitals and other health care providers working together with managed care organizations to provide integrated health care for their patients with the goals of improving their health and containing costs. Fallon Health was awarded 3 key ACO partnerships and things are going great! So great we looking to grow our workforce to support this successful initiative. Some of the Nursing talent we’re looking for include Nursing Specialties in any of the following (but not limited to): Behavioral Health, Obstetrics, Labor and Delivery, NICU, Oncology, Hospice, Palliative Care, Elder Care, Traumatic Brain Injury, Nursing Home Care, SNFs, State Agency, Hospital Case Management and more. It’s predominantly telephonic care BUT – it’s a standard 8-5 type of day with no evening or weekend shifts. You’re also not on call and won’t be asked to work holidays! Come help us build this ACO business, change the way health care is delivered to Medicaid members and use your creatively and problem solving skills! The Nurse Case Manager (NCM) Internal is focused on care coordination and improving quality of care and access to services for Fallon members. The NCM Internal supports the Clinical Integration Team in a role that does not routinely complete in-home/facility face-to-face visits with members and/or providers. Responsibilities include telephonically assessing a Members clinical/functional status to identify ongoing special conditions and providing education. Develops and implements an individualized, coordinated care plan in collaboration with the member and Primary Care Provider and/or specialist and other community partners to ensure quality outcomes in a cost effective way. Communicates with member/family/caregiver(s) in accordance with frequency of Case Management contact guidelines. Works collaboratively with other members of the Clinical Integration Team to provide overall case management, care plan oversight, and care coordination for our members ** This role is based in Worcester MA** Responsibilities Excellent communication and interpersonal skills with members and providers via telephone Exceptional customer service skills and willingness to assist ensuring timely resolution Excellent organizational skills and ability to multi-task Appreciation and adherence to policy and process requirements Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties Willingness to learn insurance regulatory and accreditation requirements Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables Accurate and timely data entry Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Demonstrates commitment to the Fallon Health Mission, Values, and Vision Specific competencies essential to this position: Problem solving Asks good questions Critical thinking skills, looks beyond the obviou Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change Demonstrates flexibility Written Communication Is able to write clearly and succinctly in a variety of communication settings and styles Qualifications Graduate from an accredited school of Nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field L icense: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits Certification : Certification in Case Management strongly desired Other: Satisfactory Criminal Offender Record Information (CORI) results PM16 PI113581735
Sep 12, 2019
Nurse Case Manager - New Role ACO - Multiple openings - Tell a Friend - Growing Healthcare Organization US-MA-Worcester Job ID: 5728 Type: Full Time # of Openings: 1 Category: Nursing 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. Calling all RN Nurse Case Managers! It’s a very exciting time to join Fallon Health in these brand new roles supporting our growth in our MassHealth ACO (Accountable Care Organization) partnerships! We have many needs so bring along your RN friends and colleagues ! In 2018, 18 health care organizations across the state were selected to participate in MassHealth’s ACO program. This involves networks of physicians, hospitals and other health care providers working together with managed care organizations to provide integrated health care for their patients with the goals of improving their health and containing costs. Fallon Health was awarded 3 key ACO partnerships and things are going great! So great we looking to grow our workforce to support this successful initiative. Some of the Nursing talent we’re looking for include Nursing Specialties in any of the following (but not limited to): Behavioral Health, Obstetrics, Labor and Delivery, NICU, Oncology, Hospice, Palliative Care, Elder Care, Traumatic Brain Injury, Nursing Home Care, SNFs, State Agency, Hospital Case Management and more. It’s predominantly telephonic care BUT – it’s a standard 8-5 type of day with no evening or weekend shifts. You’re also not on call and won’t be asked to work holidays! Come help us build this ACO business, change the way health care is delivered to Medicaid members and use your creatively and problem solving skills! The Nurse Case Manager (NCM) Internal is focused on care coordination and improving quality of care and access to services for Fallon members. The NCM Internal supports the Clinical Integration Team in a role that does not routinely complete in-home/facility face-to-face visits with members and/or providers. Responsibilities include telephonically assessing a Members clinical/functional status to identify ongoing special conditions and providing education. Develops and implements an individualized, coordinated care plan in collaboration with the member and Primary Care Provider and/or specialist and other community partners to ensure quality outcomes in a cost effective way. Communicates with member/family/caregiver(s) in accordance with frequency of Case Management contact guidelines. Works collaboratively with other members of the Clinical Integration Team to provide overall case management, care plan oversight, and care coordination for our members ** This role is based in Worcester MA** Responsibilities Excellent communication and interpersonal skills with members and providers via telephone Exceptional customer service skills and willingness to assist ensuring timely resolution Excellent organizational skills and ability to multi-task Appreciation and adherence to policy and process requirements Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, classroom, and group education Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties Willingness to learn insurance regulatory and accreditation requirements Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Familiar with Excel spreadsheets to manage work and exposure and familiarity with pivot tables Accurate and timely data entry Effective case management and care coordination skills and the ability to assess a member’s activities of daily function and independent activities of daily function and the ability to develop and implement a care plan that meets the member’s need Knowledge about community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria Ability to effectively respond and adapt to changing business needs and be an innovative and creative problem solver Demonstrates commitment to the Fallon Health Mission, Values, and Vision Specific competencies essential to this position: Problem solving Asks good questions Critical thinking skills, looks beyond the obviou Adaptability Handles day to day work challenges confidently Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change Demonstrates flexibility Written Communication Is able to write clearly and succinctly in a variety of communication settings and styles Qualifications Graduate from an accredited school of Nursing mandatory and a Bachelors (or advanced) degree in nursing or a health care related field L icense: Active, unrestricted license as a Registered Nurse in Massachusetts & current Driver’s license and a vehicle to be used for home visits Certification : Certification in Case Management strongly desired Other: Satisfactory Criminal Offender Record Information (CORI) results PM16 PI113581735
Carousel Industries, Inc Carousel Industries is an Equal Opportunity Employer: Carousel provides equal employment opportunity to all employees and applicants for employment free from unlawful discrimination based on race, color, religion, gender, age, national origin, disability, veteran status, marital status, sexual orientation or any other status or condition protected by local, state or federal law. ID 2019-2676 Job Location US-MA-Worcester # of Openings 1 Posted Date 2019-09-05 Company Overview Carousel Industries is one of the fastest growing IT companies in the US, poised for explosive growth. As a premier IT services firm, we offer an extensive portfolio of services and technologies that span the following areas: unified communications and collaboration, networking, data center, security, and cloud-based solutions. Through our partnerships with leading technology vendors-like Cisco, Avaya, Microsoft, HPE, and Fortinet, for example-Carousel offers innovative IT leadership, consultative, professional, and managed services to help our clients drive transformation within their organization. We are searching for those who are fueled by an inner drive to make a difference and to push their professional and technical capabilities to the next level. If you are someone who wants to become the "go-to person" or the "subject matter expert" in your field, then Carousel is the place for you. Ask Carousel employees what makes them stick around for 5, 10, or 20 years, and they'll tell you it's the brilliant people with whom they collaborate and the opportunities for personal and professional growth. In addition to gaining a quantum leap in your technical IQ, Carousel is a fun place with a work hard / play hard mentality and an inspiring culture. Whether it's assembling a team to compete in the next Tough Mudder or enjoying a summertime BBQ, Carousel employees consider their peers as family. To learn about our team and how you can be part of the Carousel family, find us at www.carouselindustries.com, Facebook, Twitter, and LinkedIn. Responsibilities Position Summary: This position provides the customer with a dedicated resource to assist with meeting established business objectives. As an extension of the customer's staff, the dedicated resource will be responsible for identifying and meeting their assigned customer's needs though providing service and support on the applicable equipment and products that aligns with Carousel's high standards of customer support and focus. Essential Duties and Responsibilities: Comply with all Carousel policies, processes, and procedures. Comply with all additional policies, processes, and procedures outlined by the customer. Work as directed by the customer to provide the agreed upon support on the customer's equipment, products, and/or applications. Perform diagnostics and follow comprehensive troubleshooting steps to determine the cause equipment, application, or software issues. Perform system upgrades including firmware, software, and hardware as required. Install or replace equipment which may include but is not limited to: telephones/handsets, hard drives, power supplies boards, etc. as required. Complete system and programming changes as required. Ensure accurate and timely entry of work log information detailing performed in support of a customer request. including troubleshooting steps and final resolution into applicable ticket management system. Able to work with other technical experts towards problem resolution. May be required to travel to additional customer locations. Perform other duties as assigned to meet customer expectations and business objectives. Document any changes introduced to the client environment including steps to resolution. Enter this info into appropriate Knowledge Base. May be required to travel to additional customer locations. Qualifications Experience with and the ability to complete moves, adds, and changes, administrative support, and minor break/fix support for: Avaya PBX Gateways CMS Intuity Audix VM High School Diploma or equivalent required. Applicable certifications or technical degree or a minimum 4 years of experience in a technical role. Excellent written and verbal communication skills. Excellent organizational and time management skills. Strong troubleshooting, problem solving, and analytical skills. Ability to work independently as well in a team environment. Must be able to learn new things quickly, need minimal direction, and handle multiple tasks simultaneously. Valid driver's license. Willingness to provide personal information and submit to background checks, drug screening, and health inquires as required to obtain security clearance for assigned customer. Experience with computer and database management programs. PI113483085
Sep 07, 2019
Carousel Industries, Inc Carousel Industries is an Equal Opportunity Employer: Carousel provides equal employment opportunity to all employees and applicants for employment free from unlawful discrimination based on race, color, religion, gender, age, national origin, disability, veteran status, marital status, sexual orientation or any other status or condition protected by local, state or federal law. ID 2019-2676 Job Location US-MA-Worcester # of Openings 1 Posted Date 2019-09-05 Company Overview Carousel Industries is one of the fastest growing IT companies in the US, poised for explosive growth. As a premier IT services firm, we offer an extensive portfolio of services and technologies that span the following areas: unified communications and collaboration, networking, data center, security, and cloud-based solutions. Through our partnerships with leading technology vendors-like Cisco, Avaya, Microsoft, HPE, and Fortinet, for example-Carousel offers innovative IT leadership, consultative, professional, and managed services to help our clients drive transformation within their organization. We are searching for those who are fueled by an inner drive to make a difference and to push their professional and technical capabilities to the next level. If you are someone who wants to become the "go-to person" or the "subject matter expert" in your field, then Carousel is the place for you. Ask Carousel employees what makes them stick around for 5, 10, or 20 years, and they'll tell you it's the brilliant people with whom they collaborate and the opportunities for personal and professional growth. In addition to gaining a quantum leap in your technical IQ, Carousel is a fun place with a work hard / play hard mentality and an inspiring culture. Whether it's assembling a team to compete in the next Tough Mudder or enjoying a summertime BBQ, Carousel employees consider their peers as family. To learn about our team and how you can be part of the Carousel family, find us at www.carouselindustries.com, Facebook, Twitter, and LinkedIn. Responsibilities Position Summary: This position provides the customer with a dedicated resource to assist with meeting established business objectives. As an extension of the customer's staff, the dedicated resource will be responsible for identifying and meeting their assigned customer's needs though providing service and support on the applicable equipment and products that aligns with Carousel's high standards of customer support and focus. Essential Duties and Responsibilities: Comply with all Carousel policies, processes, and procedures. Comply with all additional policies, processes, and procedures outlined by the customer. Work as directed by the customer to provide the agreed upon support on the customer's equipment, products, and/or applications. Perform diagnostics and follow comprehensive troubleshooting steps to determine the cause equipment, application, or software issues. Perform system upgrades including firmware, software, and hardware as required. Install or replace equipment which may include but is not limited to: telephones/handsets, hard drives, power supplies boards, etc. as required. Complete system and programming changes as required. Ensure accurate and timely entry of work log information detailing performed in support of a customer request. including troubleshooting steps and final resolution into applicable ticket management system. Able to work with other technical experts towards problem resolution. May be required to travel to additional customer locations. Perform other duties as assigned to meet customer expectations and business objectives. Document any changes introduced to the client environment including steps to resolution. Enter this info into appropriate Knowledge Base. May be required to travel to additional customer locations. Qualifications Experience with and the ability to complete moves, adds, and changes, administrative support, and minor break/fix support for: Avaya PBX Gateways CMS Intuity Audix VM High School Diploma or equivalent required. Applicable certifications or technical degree or a minimum 4 years of experience in a technical role. Excellent written and verbal communication skills. Excellent organizational and time management skills. Strong troubleshooting, problem solving, and analytical skills. Ability to work independently as well in a team environment. Must be able to learn new things quickly, need minimal direction, and handle multiple tasks simultaneously. Valid driver's license. Willingness to provide personal information and submit to background checks, drug screening, and health inquires as required to obtain security clearance for assigned customer. Experience with computer and database management programs. PI113483085
Join our team as a Preschool Photographer! Full and Part-time positions available! As a Photographer, you: Have the opportunity to capture several hundred smiles every week! Use a complete mobile studio and professional photography equipment ! Enjoy traveling to assigned Picture Day locations in the comfort of your own vehicle! Participate in training to increase your photography skills and experience! Will start your work day early and end about the same time as the average school day. Have summers off , between spring and fall season Picture Days! Our Preschool Photographers Enjoy Competitive hourly wage Paid drive-time Seasonal schedule flexibility (with summers off) Comprehensive paid training Requirements/Qualifications Eager to learn and deliver excellent customer service skills High School diploma or GED, strongly preferred Ability to work early morning hours Reliable, insured vehicle and valid U.S. driver's license Apply today! Lifetouch, a Shutterfly Inc. Company is an Equal Opportunity Employer. Employment with Lifetouch is contingent upon satisfactory results of a criminal background and driving record check. PI113476386
Sep 06, 2019
Join our team as a Preschool Photographer! Full and Part-time positions available! As a Photographer, you: Have the opportunity to capture several hundred smiles every week! Use a complete mobile studio and professional photography equipment ! Enjoy traveling to assigned Picture Day locations in the comfort of your own vehicle! Participate in training to increase your photography skills and experience! Will start your work day early and end about the same time as the average school day. Have summers off , between spring and fall season Picture Days! Our Preschool Photographers Enjoy Competitive hourly wage Paid drive-time Seasonal schedule flexibility (with summers off) Comprehensive paid training Requirements/Qualifications Eager to learn and deliver excellent customer service skills High School diploma or GED, strongly preferred Ability to work early morning hours Reliable, insured vehicle and valid U.S. driver's license Apply today! Lifetouch, a Shutterfly Inc. Company is an Equal Opportunity Employer. Employment with Lifetouch is contingent upon satisfactory results of a criminal background and driving record check. PI113476386
Part-Time Residential Counselor - Uxbridge house (Uxbridge) US-MA- Job ID: 2019-4031 Type: Regular Full-Time # of Openings: 1 Category: Direct Care Open Sky Community Services Overview Open Sky Community Services is a human service agency that provides counseling services and treatment options to people diagnosed with a mental illness or developmental disability. The Uxbridge House serves individuals with intellectual and mental health challenges and is staffed 24 hours a day. The focus of the program is to support each person to develop skills that will increase independence in their daily living, enhance relationships and social connections, and empower them to make decisions in all aspects of their lives. Open Sky Community Services agency provides excellent supervision (both individual and group), as well as various trainings in which to obtain CEU's, and opportunities for advancement. Our agency is an eligible employer for the Public Student Loan Forgiveness Program and provides tuition reimbursement for continuing education. Responsibilities Residential Counselors ensure a supportive, nurturing, and structured environment, while providing guidance, advocacy, and case management to the adults living in the Residential Program. Residential Counselors assist with developing and take a lead role in implementing behavior plans, assist with the daily routines, which includes assisted daily living skills, transportation and ensure safety and cleanliness of the physical site. Qualifications Bachelor's Degree in Social Services preferred. Alternative education and experience may be substituted for degree. High School diploma and valid driver's license required. PI113435352
Sep 06, 2019
Part-Time Residential Counselor - Uxbridge house (Uxbridge) US-MA- Job ID: 2019-4031 Type: Regular Full-Time # of Openings: 1 Category: Direct Care Open Sky Community Services Overview Open Sky Community Services is a human service agency that provides counseling services and treatment options to people diagnosed with a mental illness or developmental disability. The Uxbridge House serves individuals with intellectual and mental health challenges and is staffed 24 hours a day. The focus of the program is to support each person to develop skills that will increase independence in their daily living, enhance relationships and social connections, and empower them to make decisions in all aspects of their lives. Open Sky Community Services agency provides excellent supervision (both individual and group), as well as various trainings in which to obtain CEU's, and opportunities for advancement. Our agency is an eligible employer for the Public Student Loan Forgiveness Program and provides tuition reimbursement for continuing education. Responsibilities Residential Counselors ensure a supportive, nurturing, and structured environment, while providing guidance, advocacy, and case management to the adults living in the Residential Program. Residential Counselors assist with developing and take a lead role in implementing behavior plans, assist with the daily routines, which includes assisted daily living skills, transportation and ensure safety and cleanliness of the physical site. Qualifications Bachelor's Degree in Social Services preferred. Alternative education and experience may be substituted for degree. High School diploma and valid driver's license required. PI113435352
Job ID 2018-2773 Job Location Worcester, Massachusetts, United States Category Direct Care Starting Salary USD $13.46/Hr. Type Regular Full-Time Overview The Bridge House is a Group Living Environment that provides a community residence and rehabilitative services for five men and women living with serious and persistent mental illness. The goal is to assist adults in developing the skills needed for independent living. This program offers Dialectical Behavior Therapy (DBT), Illness Management and Recovery (IMR), Peer Support, and utilizes adventure-based groups and Supported Employment through the on-site day program. Alternatives provides excellent supervision (both individual and group), as well as various trainings in which to obtain CEU's, and opportunities for advancement. Alternatives is an eligible employer for the Public Student Loan Forgiveness Program and provides tuition reimbursement for continuing education. Schedule for this position typically runs either Tuesday-Saturday or Sunday-Thursday between the hours of 8am and 10pm depending on the needs of the program. Responsibilities Assist the Program Coordinator in the completion of all Assessments, Individualized Action Plans, Service Notes and Periodic Reviews according to prescribed timelines. Collaborate with individuals served and other Trans-Disciplinary Team members on the development and implementation of Individualized Action Plans (IAP's) and other recovery plans and activities. Implement activities that create opportunities for the development of valued roles and personal relationships in the community. Conduct both 1:1 and group activities geared toward increasing people's readiness to engage in rehabilitation. Assist individuals to perform daily routines. Implement all procedures that ensure the health, safety, and well being of individuals served. Implement all prescribed medical and medication protocols in accordance with agency and MAP policies. Implement all procedures that ensure physical safety and cleanliness of the program. Assist people to access, and/or provide, all needed transportation. Review and complete all required documentation. Communicate all pertinent information to all stakeholders. Attend and participate in all trainings both internal and external to Alternatives as assigned. Participate in supervision, team, and other assigned meetings. Acquire and maintain all required certifications. Perform other related tasks as assigned. Qualifications Bachelor's degree in a Social Services/Human Services related field required. Reliable vehicle and valid driver's license. Must be 20 years of age. Proficiency with Microsoft Suite including Word. First Aid, CPR, and MAP (Medication Administration Program) certified or certifiable. PI113390173
Sep 03, 2019
Job ID 2018-2773 Job Location Worcester, Massachusetts, United States Category Direct Care Starting Salary USD $13.46/Hr. Type Regular Full-Time Overview The Bridge House is a Group Living Environment that provides a community residence and rehabilitative services for five men and women living with serious and persistent mental illness. The goal is to assist adults in developing the skills needed for independent living. This program offers Dialectical Behavior Therapy (DBT), Illness Management and Recovery (IMR), Peer Support, and utilizes adventure-based groups and Supported Employment through the on-site day program. Alternatives provides excellent supervision (both individual and group), as well as various trainings in which to obtain CEU's, and opportunities for advancement. Alternatives is an eligible employer for the Public Student Loan Forgiveness Program and provides tuition reimbursement for continuing education. Schedule for this position typically runs either Tuesday-Saturday or Sunday-Thursday between the hours of 8am and 10pm depending on the needs of the program. Responsibilities Assist the Program Coordinator in the completion of all Assessments, Individualized Action Plans, Service Notes and Periodic Reviews according to prescribed timelines. Collaborate with individuals served and other Trans-Disciplinary Team members on the development and implementation of Individualized Action Plans (IAP's) and other recovery plans and activities. Implement activities that create opportunities for the development of valued roles and personal relationships in the community. Conduct both 1:1 and group activities geared toward increasing people's readiness to engage in rehabilitation. Assist individuals to perform daily routines. Implement all procedures that ensure the health, safety, and well being of individuals served. Implement all prescribed medical and medication protocols in accordance with agency and MAP policies. Implement all procedures that ensure physical safety and cleanliness of the program. Assist people to access, and/or provide, all needed transportation. Review and complete all required documentation. Communicate all pertinent information to all stakeholders. Attend and participate in all trainings both internal and external to Alternatives as assigned. Participate in supervision, team, and other assigned meetings. Acquire and maintain all required certifications. Perform other related tasks as assigned. Qualifications Bachelor's degree in a Social Services/Human Services related field required. Reliable vehicle and valid driver's license. Must be 20 years of age. Proficiency with Microsoft Suite including Word. First Aid, CPR, and MAP (Medication Administration Program) certified or certifiable. PI113390173
Notre Dame Health Care Center, Inc.
Worcester, MA, USA
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
Sep 02, 2019
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
Nurse Review - Utilization Management - Looking for a new Career? Apply at Fallon Health! US-MA-Worcester Job ID: 5676 Type: Full Time # of Openings: 1 Category: Nursing 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 UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify plans of care and/or service requests, focusing on selected complex medical and psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Fallon Health benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination. Responsibilities Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Oversee utilization management decisions completed by Senior Nurse Case Managers to ensure decisions are appropriate and identify and implement corrective action as needed. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status. Work with Medical Directors, Program Leadership and Fallon Health Provider Relations to identify and mitigate facility barriers associated with the ability to make timely decisions. Identify, align and utilize health plan and community resources that impact high-risk/high cost care. Act as liaison between assigned facilities, members/families, and Fallon Health. Clarify policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed. Assess enrollee needs and monitor progress toward goals at all times, communicating findings and status with members of the enrollee’s primary care team. Ensure optimal delivery of safe quality health care to members, while maximizing resources and containing costs, and facilitate continual patient-centered and outcome-driven health performance improvement activities. Create contingency plans to anticipate treatment and service complications, while ensuring that the enrollee attains pre-determined outcomes. Review enrollees with the Medical Directors and Primary Care Teams and advocates for Administration Exception considerations as appropriate. Facilitate communications between the facility, providers, and the PCT in order to effect and influence a safe and effective discharge plan and care plan for the enrollee. Qualifications Education : Graduate from an accredited school of nursing, or Bachelors (or advanced) degree in nursing License: Active and unrestricted licensure as a Registered Nurse in Massachusetts. Experience: A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required. 2 years’ experience as a Utilization Management nurse in a managed care payer preferred. One year experience as a case manager in a payer or facility setting highly preferred. Discharge planning experience highly preferred. JT18 PI113216475
Aug 29, 2019
Nurse Review - Utilization Management - Looking for a new Career? Apply at Fallon Health! US-MA-Worcester Job ID: 5676 Type: Full Time # of Openings: 1 Category: Nursing 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 UM Nurse uses a multidisciplinary approach to organize, coordinate, monitor, evaluate and modify plans of care and/or service requests, focusing on selected complex medical and psychosocial needs of FH members and their families. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Fallon Health benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination. Responsibilities Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Oversee utilization management decisions completed by Senior Nurse Case Managers to ensure decisions are appropriate and identify and implement corrective action as needed. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status. Work with Medical Directors, Program Leadership and Fallon Health Provider Relations to identify and mitigate facility barriers associated with the ability to make timely decisions. Identify, align and utilize health plan and community resources that impact high-risk/high cost care. Act as liaison between assigned facilities, members/families, and Fallon Health. Clarify policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed. Assess enrollee needs and monitor progress toward goals at all times, communicating findings and status with members of the enrollee’s primary care team. Ensure optimal delivery of safe quality health care to members, while maximizing resources and containing costs, and facilitate continual patient-centered and outcome-driven health performance improvement activities. Create contingency plans to anticipate treatment and service complications, while ensuring that the enrollee attains pre-determined outcomes. Review enrollees with the Medical Directors and Primary Care Teams and advocates for Administration Exception considerations as appropriate. Facilitate communications between the facility, providers, and the PCT in order to effect and influence a safe and effective discharge plan and care plan for the enrollee. Qualifications Education : Graduate from an accredited school of nursing, or Bachelors (or advanced) degree in nursing License: Active and unrestricted licensure as a Registered Nurse in Massachusetts. Experience: A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required. 2 years’ experience as a Utilization Management nurse in a managed care payer preferred. One year experience as a case manager in a payer or facility setting highly preferred. Discharge planning experience highly preferred. JT18 PI113216475
Claims Specialist - A New Career? Apply At Fallon Health! US-MA-Worcester Job ID: 5399 Type: Full Time # of Openings: 1 Category: Claims Administration 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 Position: The Claims Specialist should have advanced claim processing knowledge at the highest complexity level. Knowledge of all Claim Specialist competencies plus added responsibility for adjusting claims, working provider and member cases, and resolving edits that fire on adjustments. Advanced understanding of authorizations, benefits, contracts, enrollments, fee schedules and Fallon Health’s payment policies. Thorough knowledge of claims processing configuration and QNXT functionality. Ensures member and provider satisfaction by providing appropriate and timely processing of high complexity cases and adjustments (multi-step resolution). Monitors and resolves high volume of adjustments for all lines of business and ensures compliance with established guidelines. Must be able to work on tasks both independently and as part of a team. Responsibilities Consistently meets or exceeds all department standards: productivity, quality, and attendance. Accepts ownership and responsibility for resolving a high volume of adjustments for all lines of business. Advanced knowledge of Fallon Health policies, protocols, and procedures. Advanced understanding of authorizations, benefits, contracts, enrollments, and fee schedules. Possess a firm understanding of Fallon Health’s payment policies to accurately pay provider claims and eligible medical claims submitted for member reimbursement. Resolves complex and high dollar adjustment requests, member and provider cases, and high volume adjustment projects. Monitor and workdata integrity reports in accordance with department policies and procedures. Ensures accuracy and timeliness of adjustment processing to minimize late payment interest penalties and ensures compliance with established payment and processing guidelines. Prompt evaluation and resolution of Customer Service cases related to adjustment requests. Demonstrates solid judgment and discretion working with confidential information. Complies with all department and company guidelines including all applicable laws and regulations. Demonstrates ability to perform independently in conformance with written instructions, established timeframes, and pre-determined priorities. Demonstrates confidence by requiring minimal assistance from team subject matter experts (SME) to develop individual skills and grow professionally. Works with teams inside and outside the department, and external customers as needed. Demonstrates organizational, interpersonal, and communication skills. The above is intended to describe the general content of the requirements for the performance of the job. It is not to be interpreted as an exhaustive statement of duties, responsibilities, or requirements. Qualifications Education High school diploma, college degree preferred. Medical billing and coding or equivalent experience preferred. Experience Minimum of 3 years health care industry experience or equivalent combination of education and experience. Advanced knowledge of CPT, ICD-10, HCPCS coding guidelines and medical terminology preferred. Demonstrated ability to accurately data enter and proficiently process high complexity claims. Advanced understanding of all technical applications related to claim processing including system workflow and design and benefit determination. MS Office and general PC skills. Specific competencies essential to this position: Analytical ability – Gathers relevant information systematically. Considers a full range of issues or factors. Grasps complexities and perceives relationships among problems or issues. Seeks input from others as appropriate. Problem solving – Solves high complexity problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Looks beyond the obvious Results oriented – Can be counted on to consistantly exceed quality and productivity goals. Is consistantly one of the top performers. Routinely pushes self for improvement in results . JT18 PI113216477
Aug 29, 2019
Claims Specialist - A New Career? Apply At Fallon Health! US-MA-Worcester Job ID: 5399 Type: Full Time # of Openings: 1 Category: Claims Administration 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 Position: The Claims Specialist should have advanced claim processing knowledge at the highest complexity level. Knowledge of all Claim Specialist competencies plus added responsibility for adjusting claims, working provider and member cases, and resolving edits that fire on adjustments. Advanced understanding of authorizations, benefits, contracts, enrollments, fee schedules and Fallon Health’s payment policies. Thorough knowledge of claims processing configuration and QNXT functionality. Ensures member and provider satisfaction by providing appropriate and timely processing of high complexity cases and adjustments (multi-step resolution). Monitors and resolves high volume of adjustments for all lines of business and ensures compliance with established guidelines. Must be able to work on tasks both independently and as part of a team. Responsibilities Consistently meets or exceeds all department standards: productivity, quality, and attendance. Accepts ownership and responsibility for resolving a high volume of adjustments for all lines of business. Advanced knowledge of Fallon Health policies, protocols, and procedures. Advanced understanding of authorizations, benefits, contracts, enrollments, and fee schedules. Possess a firm understanding of Fallon Health’s payment policies to accurately pay provider claims and eligible medical claims submitted for member reimbursement. Resolves complex and high dollar adjustment requests, member and provider cases, and high volume adjustment projects. Monitor and workdata integrity reports in accordance with department policies and procedures. Ensures accuracy and timeliness of adjustment processing to minimize late payment interest penalties and ensures compliance with established payment and processing guidelines. Prompt evaluation and resolution of Customer Service cases related to adjustment requests. Demonstrates solid judgment and discretion working with confidential information. Complies with all department and company guidelines including all applicable laws and regulations. Demonstrates ability to perform independently in conformance with written instructions, established timeframes, and pre-determined priorities. Demonstrates confidence by requiring minimal assistance from team subject matter experts (SME) to develop individual skills and grow professionally. Works with teams inside and outside the department, and external customers as needed. Demonstrates organizational, interpersonal, and communication skills. The above is intended to describe the general content of the requirements for the performance of the job. It is not to be interpreted as an exhaustive statement of duties, responsibilities, or requirements. Qualifications Education High school diploma, college degree preferred. Medical billing and coding or equivalent experience preferred. Experience Minimum of 3 years health care industry experience or equivalent combination of education and experience. Advanced knowledge of CPT, ICD-10, HCPCS coding guidelines and medical terminology preferred. Demonstrated ability to accurately data enter and proficiently process high complexity claims. Advanced understanding of all technical applications related to claim processing including system workflow and design and benefit determination. MS Office and general PC skills. Specific competencies essential to this position: Analytical ability – Gathers relevant information systematically. Considers a full range of issues or factors. Grasps complexities and perceives relationships among problems or issues. Seeks input from others as appropriate. Problem solving – Solves high complexity problems with effective solutions. Asks good questions. Can see underlying or hidden problems and patterns. Looks beyond the obvious Results oriented – Can be counted on to consistantly exceed quality and productivity goals. Is consistantly one of the top performers. Routinely pushes self for improvement in results . JT18 PI113216477
Notre Dame Health Care Center, Inc.
Worcester, MA, USA
Who We Are: Notre Dame Health Care Center, Inc. (NDHCC) 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 Top rated Assisted Living provides high quality compassionate care to the Central MA community for over 20 years. We are seeking a skilled and passionate Cook to join our team at Notre Dame. The cook will be leading, cooking, serving and interacting with residents of our Assisted Living facility. If you are an experienced culinary professional with an enthusiasm for interacting with people, this is the ideal opportunity for you! Responsibilities include (but are not limited to): Prepare ingredients for cooking, including portioning, chopping, and storing food before use. Weigh, measure, and mix ingredients according to recipes or personal judgment, using various kitchen utensils and equipment. Prepare and cook food according to recipes. Serve food (for example, soup, desserts, sides, entres) in proper portions onto dishes, plates, mugs, and bowls, ensuring proper plate appearance. Ensure proper portion, arrangement, and food garnish to be served to waiters or patrons, according to standards. Ensure food storage areas are clean. Follow appropriate personal hygiene procedures to ensure food served to residents is safe for consumption. Follow and ensure compliance with food safety and handling policies and procedures. Communicate any assistance needed during busy periods to the Chef to ensure optimum service to residents. Ensure the quality of the food items and notify manager if a product does not meet specifications. Check and ensure the correctness of the temperature of appliances and food using thermostats and thermometers, including monitoring freezer systems, such as fans, drains, and doors, for proper operation, and report issues or problems to facility management. Report maintenance issues immediately to appropriate personnel (i.e., management or maintenance). Maintain up-to-date knowledge of company Food Safety Programs within assigned area of responsibility, as well as all local, state, and federal regulations. Ability to work under demanding and strenuous situations. PM17
Aug 19, 2019
Who We Are: Notre Dame Health Care Center, Inc. (NDHCC) 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 Top rated Assisted Living provides high quality compassionate care to the Central MA community for over 20 years. We are seeking a skilled and passionate Cook to join our team at Notre Dame. The cook will be leading, cooking, serving and interacting with residents of our Assisted Living facility. If you are an experienced culinary professional with an enthusiasm for interacting with people, this is the ideal opportunity for you! Responsibilities include (but are not limited to): Prepare ingredients for cooking, including portioning, chopping, and storing food before use. Weigh, measure, and mix ingredients according to recipes or personal judgment, using various kitchen utensils and equipment. Prepare and cook food according to recipes. Serve food (for example, soup, desserts, sides, entres) in proper portions onto dishes, plates, mugs, and bowls, ensuring proper plate appearance. Ensure proper portion, arrangement, and food garnish to be served to waiters or patrons, according to standards. Ensure food storage areas are clean. Follow appropriate personal hygiene procedures to ensure food served to residents is safe for consumption. Follow and ensure compliance with food safety and handling policies and procedures. Communicate any assistance needed during busy periods to the Chef to ensure optimum service to residents. Ensure the quality of the food items and notify manager if a product does not meet specifications. Check and ensure the correctness of the temperature of appliances and food using thermostats and thermometers, including monitoring freezer systems, such as fans, drains, and doors, for proper operation, and report issues or problems to facility management. Report maintenance issues immediately to appropriate personnel (i.e., management or maintenance). Maintain up-to-date knowledge of company Food Safety Programs within assigned area of responsibility, as well as all local, state, and federal regulations. Ability to work under demanding and strenuous situations. PM17
Notre Dame Health Care Center, Inc.
Worcester, MA, USA
Notre Dame Health Care, the operator of a five-star rated rehab and long term care center, assisted living residence, memory care units, Medicare licensed hospice, palliative and pediatric care programs, care management program, and an educational center, all located in Worcester, MA seeks a Certified Nursing Assistant (CNA) to provide care giving duties to our residents in the Long Term Care facility. Certified Nursing Assistant (C.N.A.) Job Responsibilities: 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 Maintenance of a clean, safe and healthy environment Other activities as taught by a licensed health professional employee Assisting with tasks associated with elimination including, but not limited to toileting, assisting with the use of the bedpan and urinal, providing catheter care including changing the urinary catheter bag, collecting specimens, and/or emptying ostomy bags, or changing bags that do not adhere to the skin. Assisting with the use of devices such as a wheelchair or walker Assisting with prescribed range of motion exercises Keeping records of personal health care activities. Observing appearance and gross behavioral changes in the patient and reporting to the RN. PM17
Aug 19, 2019
Notre Dame Health Care, the operator of a five-star rated rehab and long term care center, assisted living residence, memory care units, Medicare licensed hospice, palliative and pediatric care programs, care management program, and an educational center, all located in Worcester, MA seeks a Certified Nursing Assistant (CNA) to provide care giving duties to our residents in the Long Term Care facility. Certified Nursing Assistant (C.N.A.) Job Responsibilities: 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 Maintenance of a clean, safe and healthy environment Other activities as taught by a licensed health professional employee Assisting with tasks associated with elimination including, but not limited to toileting, assisting with the use of the bedpan and urinal, providing catheter care including changing the urinary catheter bag, collecting specimens, and/or emptying ostomy bags, or changing bags that do not adhere to the skin. Assisting with the use of devices such as a wheelchair or walker Assisting with prescribed range of motion exercises Keeping records of personal health care activities. Observing appearance and gross behavioral changes in the patient and reporting to the RN. PM17
Notre Dame Health Care Center, Inc.
Worcester, MA, USA
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 award winning Long Term Care facility seeks a 24 Hours a week LPN 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. Responsibilities: Check all ill residents early in the shift, make periodic assessments, report changes to appropriate personnel, make appropriate interventions and document these in Medical Record. Continually assess resident care needs and apply findings to the development of the Minimum Data Set, Resident Assessment protocols and Interdisciplinary care plans for each resident. Reports changes in resident condition to Supervisor, attending physician/NP and families as necessary and document in Medical Record. See that all required documentation is correct, reflects need and is up-to-date with no omissions. Collaborate with Nursing Assistants in accurate documentation. Administer and record prescribed medications and treatments. Assess residents on admission and initiates interim care plan. Work with the Supervisors and SNAs in the supervision of ancillary personnel in the delivery of quality care and service and in the accurate documentation of resident care needs. Interpret policies/procedures to ancillary staff, residents, families, and visitors. Uphold Infections Control policies/practices and those of the Quality Assurance & Improvement Committee. Delegate duties appropriately and supervise unlicensed assistive personnel. Render emergency care as needed, report to supervisor; submit complete, accurate, and timely incident reports as necessary. PM17
Aug 19, 2019
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 award winning Long Term Care facility seeks a 24 Hours a week LPN 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. Responsibilities: Check all ill residents early in the shift, make periodic assessments, report changes to appropriate personnel, make appropriate interventions and document these in Medical Record. Continually assess resident care needs and apply findings to the development of the Minimum Data Set, Resident Assessment protocols and Interdisciplinary care plans for each resident. Reports changes in resident condition to Supervisor, attending physician/NP and families as necessary and document in Medical Record. See that all required documentation is correct, reflects need and is up-to-date with no omissions. Collaborate with Nursing Assistants in accurate documentation. Administer and record prescribed medications and treatments. Assess residents on admission and initiates interim care plan. Work with the Supervisors and SNAs in the supervision of ancillary personnel in the delivery of quality care and service and in the accurate documentation of resident care needs. Interpret policies/procedures to ancillary staff, residents, families, and visitors. Uphold Infections Control policies/practices and those of the Quality Assurance & Improvement Committee. Delegate duties appropriately and supervise unlicensed assistive personnel. Render emergency care as needed, report to supervisor; submit complete, accurate, and timely incident reports as necessary. PM17