Fallon Health

• Establish, design and support an enterprise cloud architecture that provides the required capacity plans. Supports the long-term strategic goals for enterprise cloud technologies within the Health Plan. • Develop workload migration plan in conjunction with data owners and other technical resources • Work with systems and database administrators to implement cloud architectures that utilize industry best practices • Deploy and configure technologies and corresponding software • Implement cloud technology policies, and procedures for disaster recovery and archiving to ensure effective protection and integrity of storage appliances and stored data assets • Establish appropriate end-user access control levels for stored data • Perform tasks necessary to fulfill service level agreements with end-users regarding security, and availability • Review and deploy cloud system releases and vendor-supplied patches according to best practices • Follow change control, incident response, and testing processes for modifications to cloud technologies and software • Anticipate, mitigate, identify, respond to, and resolve issues with cloud, storage access, and data retrieval • Research and make recommendations on cloud products, services, and standards in support of procurement and development efforts • Monitor, analyze, and predict trends for cloud infrastructure performance, space allocation, and data growth to recommend enhancements to the IT storage team • Create power shell scripts to support automation and administrative simplification • Maintain cloud systems support and architecture documentation • Manage and/or provide guidance to junior members of the team • Works off hours to provide support for systems administration • Provide clear, helpful and considerate instructions to end-users

• Manage, plan, and direct the daily operations of the EDI Department to ensure accurate, timely, and efficient execution of all EDI functions across Fallon Health • Accountable for ensuring the EDI team operates at peak effectiveness • Oversee the end-to-end EDI lifecycle for the organization, including tracking incoming and outgoing EDI files and monitoring unsuccessful transmissions • Provide oversight of EDI claims reconciliation processes to ensure accuracy • Act as a liaison between EDI, IT, Configuration, and other internal departments to resolve day-to-day operational issues

• Conduct telephonic and in-home assessments; create individualized care plans with members and care teams • Advocate for members to access benefits and community resources • Foster relationships with members, families, and providers to ensure timely, cost-effective care

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Nurse Case Manager (NCM) is an integral part of an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members, specifically for Medicare and Community Care membership. The NCM seeks to establish telephonic relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with member specific needs and quality metrics developed by the NCM and support team. - Regular telephonic assessments, care planning, and identifying member specific priorities. - Familiarity with quality metrics including STARS and HEDIS as well as guiding factors within the NCQA standards. - Emphasis on complex case management, reducing readmission rates, and ensuring that members’ needs are met at time of transition from ER/inpatient hospitalization to home. - Understanding the effect of social determinants of health on health outcomes and aligning members with community supports. Qualifications - Graduate from an accredited school of nursing mandatory. - Bachelors (or advanced) degree in nursing or a health care related field preferred. - Active, unrestricted license as a Registered Nurse in Massachusetts. - Certification in Case Management strongly desired. - Satisfactory Criminal Offender Record Information (CORI) results and reliable transportation. - 1+ years of clinical experience as a Registered Nurse managing chronically ill members or experience in a coordinated care program required. - Understanding of hospitalization experiences and the impacts and needs after facility discharge required. - Experience working face to face with members and providers preferred. - Experience with telephonic interviewing skills and working with a diverse population required. - Home Health Care experience preferred. - Effective case management and care coordination skills preferred. - Familiarity with NCQA, CAHPS and Stars/HEDIS metrics preferred. Requirements - Excellent communication and interpersonal skills with members and providers via telephone and in person. - 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. - Knowledgeable about software systems including Microsoft Office Products. - Ability to effectively respond and adapt to changing business needs. Benefits - Pay range for this position is $88,000 - $95,000 per year. - Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Overview About Fallon Health: Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality. Brief Summary of Purpose: The Accountable Care Organization ACO Behavioral Health Case Manager I (BHCM I) is an integral part on an interdisciplinary team focused on transition of care assessment and support, care coordination, care management and improving access to and quality of care for Fallon Health ACO members. The BHCM I embed in the ACO Partner Provider Offices and works closely with ACO Partner Providers, Office Staff, Care Management Staff and others at the Partner sites managing member care. BHCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the BHCM I and Care Team. Responsibilities may include conducting in home/office face to face visits for members identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The BHCM I conduct assessments and refers members to Community Partner Programs such as Behavioral Health and Long-Term Services and Supports. The BHCM I may also refer members to Flex Program as applicable depending upon the ACO the member is affiliated with. The BHCM I may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Responsibilities include: Member Assessment & Education - Telephonic and in-home assessments; create individualized care plans with members and care teams. - Perform care transition assessments and maintain knowledge of program benefits and policies. - Educate members/caregivers on disease management and self-care. - Advocate for members to access benefits and community resources (e.g., housing, food, transportation). Care Coordination & Collaboration - Develop member-centered care plans and monitor progress toward goals. - Coordinate with Nurse Case Managers, Navigators, Social Care Managers, and community partners. - Foster relationships with members, families, and providers to ensure timely, cost-effective care. - Participate in clinical rounds and report safety concerns to Protective Services as needed. Provider & Regulatory Responsibilities - Attend care plan meetings and provider visits, lead reviews when applicable. - Complete assessments, notes, and care plans in TruCare and EMR systems. - Serve as a behavioral health consultant and provide training as needed. - Collaborate with Fallon Health, Beacon Health Options, and contracted providers to ensure timely mental health and substance use supports. - Maintain HIPAA compliance and attend required meetings and supervision. Other - Support quality initiatives and department projects. - Cover assignments as needed and perform other duties as directed. Qualifications Education - Master’s degree from an accredited school of social work, mental health counseling, psychology License: - LCSW, Master’s MA/MS in Mental Health Counseling – under clinical supervision Certification: - Certification in Case Management a plus Other: - Satisfactory Criminal Offender Record Information (CORI) results. - This role requires compliance with the ACO Partner Health and Educational requirements. Experience: - Four + years clinical experience in the behavioral health/mental health setting required - Experience with government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred. Performance Requirements including but not limited to: - Ability to conduct behavioral health assessments, develop and implement comprehensive care plans that addresses the member’s behavioral health needs in conjunction with their medical needs and social determinants of health - Ability to serve as a member on an interdisciplinary care team that may include the member’s primary care physician, medical providers, behavioral health providers, state agencies and/or internal nurse case managers and navigators - Ability to screen and assist members with social determinants of health including but not limited to relevant food, housing and state applications (e.g., DDS, DYS, DCF, DMH) - Experience with subpopulations including children, adolescents, the homeless, those with SPMI, substance use disorders, and disabilities - Effective case management, care coordination, and member advocacy skills - Knowledge about behavioral health community resources, levels of care, and criteria for levels of care - Familiarity with motivational interviewing and harm reduction to engage and connect with members - Ability to work collaboratively with BH vendor - Familiarity with software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $92,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. 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. #P02

Overview About us: Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. 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 (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.   Brief summary of purpose:  The Social Work Care Manager (SWCM) works very closely with Fallon Health Care Team staff, Provider Partners, Community Partners, and/ or community-based groups to address service gaps and serves as a liaison to social and health resources on behalf of Fallon Health and the Fallon Health Care Management Models of Care. The SWCM collaborates and coordinates with State Agencies, DMH, DDS, DYS, DCF to ensure members care is efficient and coordinated. The SWCM provides social service coordination services to members as referred assessing member needs, services and resources to address social, health, or economic needs and facilitates referrals and collaboration with Provider Care Teams and BH Partners in the community. The SWCM assists the member and or family to provide care utilizing FH benefits and/or community resources developing a plan to coordinate a continuum of care consistent with the members’ health care needs and/or goals. The SWCM uses their knowledge of benefit plan design, eligibility and/or financing alternatives available within the community to provide options that meet member’s needs. The SWCM identifies services, care delivery settings, and funding arrangements that meet the needs of the members. They recommends alternatives where appropriate. The SWCM monitors services and provides consistent feedback to the team on progress. The SWCM collaborates and works with members of the Care Team both at Fallon Health and at the Community Partners during time of member transition of care. May attend in person care planning meetings, care coordination meetings, partner communication meetings, and other face-to-face meetings with providers, partners, and members to perform assessments, train staff, coordination communication and otherwise represent Fallon Health in a positive way. SWCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the BHCM and Care Team. Responsibilities may include conducting in home/office face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The SWCM conducts assessments and refers members to community resources. The SWCM may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Primary Job Responsibilities:   Member Care Coordination and Collaboration o Provides culturally appropriate care coordination, i.e., works with interpreters, provides communication approved documents     in the appropriate language, and demonstrates culturally appropriate behavior when working with member, family, caregivers,     and/or authorized representatives o With member/authorized representative(s) collaboration develops member centered care plans by identifying member care    needs while completing program assessments and working with the Care Coordinator to ensure the member approves their    care plan o Monitors progression of member goals and care plan goals, provides feedback and works collaboratively with care team    members and work effectively in a team model approach to coordinate a continuum of care consistent with the Member’s    health care goals and needs o Actively participates in internal clinical rounds and huddles o Works with members of the Utilization Management Department assisting with difficult or complex care delivery or discharge    planning needs for members o Actively participate with Beacon team and collaborate on high-risk members to decrease utilization o May collaborate with staff on site to facilitate communication between Fallon and community-based teams o Assists with care coordination with community Partners to engage in Interdisciplinary team meetings o Works with Nurse Case Managers and Navigators to coordinate a continuum of care for members consistent with the    member’s health care goals and needs o Maintains an ongoing awareness of clinical, social, and financial resources available in the community as well as    State/Federal and National Resources and connects and advocates for members as appropriate o Performs other responsibilities as assigned by a member of the Clinical Integration Leadership Team    Provider Partnerships and Collaboration o May attend in person member/provider visits, care plan meetings with providers and office staff and may lead care plan    review with providers and care team as applicable o Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs    are met Regulatory Requirements – Actions and Oversight o Completes Program Assessments, Notes, Screenings, and Care Plans in the TruCare and Provider EMR systems according     to Program policies and processes Provides training and consultation o Offers recommendations to continued program development and is an active participant in suggesting opportunities to enhance     the program o Works with Fallon Health Provider Relations and Beacon Health Options to ensure that contracted behavioral health providers    are knowledgable about the plan benefits, eligibility requirements, and care coordination and communication needs o Coordinate with Beacon staff to ensure quality and timely arrangement of necessary mental health and substance use supports.    Attends Fallon Health/Beacon meetings when requested o Attends supervision and 1:1 meetings with Leader. Attends Team Huddles, staff meetings, site meetings and other Fallon Health    and business related meetings as required. Meetings may be in person or telephonic depending upon the need Other o Performs other responsibilities as assigned by the Manager/designee o Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/designee Qualifications Education: Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required   License/Certifications: Certification: Certification in Case Management a plus Other: Satisfactory Criminal Offender Record Information (CORI) results   Experience: Four years of experience working with the following: the chronically ill, SPMI, and substance use populations required Experience and comfort conducting face-to-face visits with members in the community and in home settings required Experience working in a multi-disciplinary care team required Experience working and providing collaborative care management interventions with various State Agencies such as DMH, DDS, DCF, DYS required Experience working with provider groups such as medical and/or mental health providers required Background working with all age groups preferred Previous experience working at a Managed Care Organization preferred   Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $78,000 - $82,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.   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.   #P03

Overview About Fallon Health: Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality. Brief Summary of Purpose: The Accountable Care Organization ACO Behavioral Health Case Manager I (BHCM I) is an integral part on an interdisciplinary team focused on transition of care assessment and support, care coordination, care management and improving access to and quality of care for Fallon Health ACO members. The BHCM I embed in the ACO Partner Provider Offices and works closely with ACO Partner Providers, Office Staff, Care Management Staff and others at the Partner sites managing member care. BHCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member specific care plan developed by the BHCM I and Care Team. Responsibilities may include conducting in home/office face to face visits for members identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The BHCM I conduct assessments and refers members to Community Partner Programs such as Behavioral Health and Long-Term Services and Supports. The BHCM I may also refer members to Flex Program as applicable depending upon the ACO the member is affiliated with. The BHCM I may utilize an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction. Responsibilities Responsibilities include: Member Assessment & Education - Telephonic and in-home assessments; create individualized care plans with members and care teams. - Perform care transition assessments and maintain knowledge of program benefits and policies. - Educate members/caregivers on disease management and self-care. - Advocate for members to access benefits and community resources (e.g., housing, food, transportation). Care Coordination & Collaboration - Develop member-centered care plans and monitor progress toward goals. - Coordinate with Nurse Case Managers, Navigators, Social Care Managers, and community partners. - Foster relationships with members, families, and providers to ensure timely, cost-effective care. - Participate in clinical rounds and report safety concerns to Protective Services as needed. Provider & Regulatory Responsibilities - Attend care plan meetings and provider visits, lead reviews when applicable. - Complete assessments, notes, and care plans in TruCare and EMR systems. - Serve as a behavioral health consultant and provide training as needed. - Collaborate with Fallon Health, Beacon Health Options, and contracted providers to ensure timely mental health and substance use supports. - Maintain HIPAA compliance and attend required meetings and supervision. Other - Support quality initiatives and department projects. - Cover assignments as needed and perform other duties as directed. Qualifications Education - Master’s degree from an accredited school of social work, mental health counseling, psychology License: - LCSW, Master’s MA/MS in Mental Health Counseling – under clinical supervision Certification: - Certification in Case Management a plus Other: - Satisfactory Criminal Offender Record Information (CORI) results. - This role requires compliance with the ACO Partner Health and Educational requirements. Experience: - Four + years clinical experience in the behavioral health/mental health setting required - Experience with government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred. Performance Requirements including but not limited to: - Ability to conduct behavioral health assessments, develop and implement comprehensive care plans that addresses the member’s behavioral health needs in conjunction with their medical needs and social determinants of health - Ability to serve as a member on an interdisciplinary care team that may include the member’s primary care physician, medical providers, behavioral health providers, state agencies and/or internal nurse case managers and navigators - Ability to screen and assist members with social determinants of health including but not limited to relevant food, housing and state applications (e.g., DDS, DYS, DCF, DMH) - Experience with subpopulations including children, adolescents, the homeless, those with SPMI, substance use disorders, and disabilities - Effective case management, care coordination, and member advocacy skills - Knowledge about behavioral health community resources, levels of care, and criteria for levels of care - Familiarity with motivational interviewing and harm reduction to engage and connect with members - Ability to work collaboratively with BH vendor - Familiarity with software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word Pay Range Disclosure: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $88,000 - $92,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities. 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. #P02

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This is a 3 months temporary contract position for a Prior Authorization RN. The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations), focusing on selected complex medical and psychosocial needs of FH members and their families. The PA 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 pre-service, concurrent, and retrospective reviews for outpatient services such as elective procedures, home health care, DME, nutrition, and genetic testing utilizing established state, federal, and internally developed benefit and clinical coverage criteria against FH policies and protocols. Medical necessity determinations are reviewed with the holistic picture of the member in mind, which requires exceptional attention to detail, proficiency in applying correct criteria, and collaboration with internal and external partners. Responsibilities - Obtain clinical, functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with other health care professionals, member and/or family. - Refer cases to medical review according to policy and procedure. - Document clinical, functional, psychosocial information in the Core System as well as communications regarding the members’ care. - Keep records and submit reports as assigned by the Manager. - Refer high-risk cases to the appropriate FH internal teams (ie: Outpatient Case Management, NaviCare, ACO) and/or other community services according to department protocol. - Collaborate with attending physicians and health care professionals regarding appropriate utilization of medical services. - Complete level of care/service request reviews strictly adhering to regulatory turnaround time guidelines such as, but not limited to, CMS, NCQA, and the DOI. - Identify utilization issues unique to their team assignment and identify strategies to address/resolve these issues. - Issue regulatory and other letters according to the department policies and procedures. - Keep electronic copies of all denial letters and related documents in the Fallon Health core application and/or the organization’s security accessed drive(s). - Act as a liaison between Providers, vendors, facilities, members/families, and Fallon Health internal departments. Clarify policies/procedures and member benefits as needed. Authorize services, coordinate care, and ensure timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed. - Work with Fallon Health providers/support staff and/or members to facilitate cost-effective, quality care. - Request and obtain relevant clinical information from medical care providers as needed for the clinical review process. - Conduct pre-authorization and concurrent clinical reviews requests for services such as DME, elective procedures, Home Health Care, Out of network specialty care, transportation and genetics, against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status. - Refer all cases that do not meet medical necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred case. - Incrementally monitor the effectiveness of established plans of care with defined, measurable goals and objectives and cost-benefit documentation as applicable and modify the care plan when applicable. - Streamline the focus of the member’s healthcare needs utilizing the most optimal treatment approach, promoting timely provision of care, enhancing quality of life, and promoting cost-effectiveness of care. - Analyze and apply CMS always INPT and SDS CPT codes during PA clinical reviews when a surgical procedure is requested as IP LOC. - Collaborate with Fallon Health departments to ensure services/items needed to facilitate discharge from a post-acute or hospital setting do not delay discharge. - Collaborate with external providers on alternative coverage options when services requested do not meet medical necessity, benefit eligibility, and network contract status criteria. - Create contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the member attains pre-determined outcomes. - Review physician reviewers’ determinations for appropriateness and completeness. - Communicate determinations to providers and members telephonically and in writing, adhering to corporate/department policy and regulatory guidelines. - Check voicemail at regular intervals throughout the day and return calls/messages within the same day of receipt. - Strictly observe the Fallon Health policies regarding confidentiality of member information, documentation standards, meeting any education requirements, and perform other responsibilities as assigned by department management team. - Participate in weekly medical rounds with the leadership team, Medical Directors, and various Fallon Health departments to discuss patient issues and/or concerns. Organize and present complex medical cases in a clear and concise oral and written manner. - Ensure ad hoc contracts are in place for non-contracted services working in conjunction with FH Network Development team. Qualifications - Graduate from an accredited school of nursing, Associate’s Degree, Bachelors Degree, or advanced degree in nursing required. - Active and unrestricted licensure as a Registered Nurse in Massachusetts. - 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/Prior Authorization nurse in a managed care payer preferred. - One year experience as a case manager in a payer or facility setting highly preferred. - Relevant experience may include but not be limited to experience working directly in the field of Home Health Care, Ambulatory Provider Setting, Rehabilitation Nursing Setting, Acute Hospital Setting. - Relevant experience may include, but not be limited to experience processing authorizations for services such as: - Outpatient authorization requests such as: - Home Health Care - DME - Ambulatory Procedures - Genetic Testing - Pharmacy - Nutritional supplies - Inpatient authorization requests such as: - Acute Hospital Level of Care - Post-Acute level of care reviews (SNF, Acute Rehab, Long Term Acute Care) Company Description 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, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. 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 (Program of All-Inclusive Care for the Elderly)— in the region.