Rehab Manager - Lowell- PACE program 55 + NO NIGHTS NO WEEKENDS

About us:

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation's top health plans for member experience, service, and clinical quality.

Fallon Health's Summit ElderCare is a Program of All-Inclusive Care for the Elderly-PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique.

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid, and PACE- in the region.

Brief summary of purpose:

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

Primary Job Responsibilities:

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

Education:

Graduate of an accredited program in Physical or Occupational Therapy.

License/Certifications

• Licensed as a physical or occupational therapist in Massachusetts
• CPR certification or willingness to obtain
• Access to reliable transportation to perform work throughout the PACE center's service area (30-mile radius) when needed. Willingness to occasionally assist other SE PACE centers either in person or remotely, as appropriate, when there is an opening or a gap in coverage.

Experience:

• At least one year experience working with a frail or elderly population in a health care setting.
• At least 2 years management or supervisory experience preferred.
• Experience in home or outpatient settings preferred. PACE experience preferred.
• Functions independently in the day to day management of the rehabilitation needs of participants and the operations of the PACE center Rehabilitation Department utilizing FH and Summit ElderCare policies and procedures, leadership guidance and program goals in the decision making process.
• Ability to work with an electronic medical/participant record.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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