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Fallon Health Fallon Health Weinberg Navigator in Amherst, NY, New York


Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022, all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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.

About Fallon Health Weinberg-MLTC:

Fallon Health Weinbergis a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high-quality, affordable health care.

All care is coordinated and provided by an interdisciplinary team specializing in geriatric care, who work with participants and their caregivers to create an individualized care plan.

Brief Summary of Purpose:

The Navigator helps the primary care provider, care manager, community liaisons and other providers know at all times what is occurring with the Member and their status. Responsibilities include: placing referrals and following up to ensure services are in place as per the individual care plan; coordinating and documenting Inter-Disciplinary Care Team meetings, facilitating data transfers and ensuring the Centralized Enrollee Record (CER) and Core System is up to date. The Navigator works closely with the Care Manager. The Navigator refers to the Care Manager whenever clinical decision making is required. In order to effectively advocate for Enrollee needs, the Navigator makes in home visits/long term care facility visits with/without the Care Manager to fully understand an Enrollee/member care needs.

The Navigator seeks to establish a relationship with the Enrollee/member/caregiver(s)/facilities to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.


Primary Job Responsibilities :

  • Acts as Enrollees advocate

  • Gathers data from the Enrollee’s medical record in areas such as preventative health screenings, working with the Enrollee and Primary Care Provider to ensure the Enrollee receives health care according to established guidelines

  • Responds to Enrollee/caregiver/Facility questions or concerns about their health/benefits

  • Makes in home/institutional/office visits as need be to introduce self/role and ensure the Enrollee/caregiver/facility is orientated to the Program and benefits

  • Coordinates Enrollee visits to the Primary Care Physician (PCP) and other clinicians as appropriate based upon clinical need and program guidelines, including but not limited to ensuring adequate transportation

  • Coordinates/schedules IDT meetings on a regular basis depending upon Enrollee needs according to Department guidelines

  • Ensures IDT meeting summaries are entered/scanned into the CER per Department process

  • Coordinates and ensures members of the Care Team (i.e. Director of Clinical Service, Care Manager, and others) are involved and knowledgeable about the Enrollee status based upon Enrollee need and PCP/PCT direction at all times

  • Ensures authorizations for specific covered services are entered into the CER as appropriate based upon Department processes

  • Ensures the Enrollee’s Individual Plan of Care (IPC) is up to date in conjunction with plans developed by members of the Primary Care Team/Primary Care Physician

  • Ensures the Enrollee is in agreement with their IPC and documents Enrollee approval of such in the CER

  • Ensures the Care Manager follows up with Enrollees after an emergent/urgent care need and/or care transition such as a hospitalization or skilled nursing facility admission

  • Works with the emergent/urgent/acute care/skilled nursing facility provider to obtain discharge documentation and ensures information is entered/scanned into the CER per Department process and shared with all members of the team

  • Responsible for updating and maintaining accuracy of panel access data base lists – processes according to Department guidelines

  • Identifies and shares best practices and innovative care management strategies with the team

  • Resolves conflicts among participants in the care planning process

  • Creates contingency plans for each step of the process to anticipate treatment and service complications, while ensuring that the Enrollee attains pre-determined outcomes

  • Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/designee

  • Strictly observes HIPPA regulations and the FHW policies regarding confidentiality of member information

  • Performs other responsibilities as assigned by the Supervisor/designee.



High School degree. Graduation from an accredited Licensed Practical Nurse Program


Current NY Driver's License, Current License to practice as an LPN in the state of NY




  • 1 year job experience in a medical related field or with a healthcare payor company a plus

  • Experience with telephonic/person interviewing skills

  • English as a second language a plus

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


Location US-NY-Amherst, NY

Posted Date 2 weeks ago (6/15/2022 3:10 PM)

Job ID 6901

# Positions 1

Category Medical Management