PCA Electronic Visit Verification Program Manager-Part Time

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 Or Purpose

The MassHealth PCA EVV Program Manager is responsible for leading, coordinating, and sustaining compliance with Electronic Visit Verification (EVV) requirements within the MassHealth Personal Care Attendant (PCA) Program. This role ensures regulatory adherence while preserving access to consumer-directed care, supporting staff implementation, and mitigating operational and compliance risk. The Program Manager serves as the central EVV subject matter expert and operational lead, bridging state policy, fiscal intermediary requirements, and frontline care delivery as well presenting updates to the State on compliance and follow up.

Responsibilities

Primary Job Responsibilities

Program Leadership & EVV Oversight

• Lead all aspects of PCA EVV operations, including large-scale EVV transitions for members.
• Serve as the primary liaison with Tempus Unlimited, MassHealth, and EOHHS regarding EVV requirements and implementation.
• Ensure compliance with federal, state, and contractual EVV regulations.
  
  

EVV Policy, Workflow & Process Development

• Develop and maintain standardized EVV non-compliance workflows, escalation pathways, and staff guidance.
• Create and update member-facing communication templates, including warning and strike notifications.
• Partner with Authorization teams to support termination, disregard, and coverage decision letters.
  
  

Training, Education & Staff Support

• Provide ongoing EVV training to care teams through meetings, huddles, and case consultations.
• Support staff in assessing compliance status and addressing member-specific EVV barriers.
  
  

Compliance Monitoring & Case Management

• Maintain EVV tracking tools to ensure accurate compliance documentation and escalation.
• Troubleshoot EVV discrepancies with internal teams and fiscal intermediary partners.
• Monitor post-remediation compliance performance as required.
  
  

High-Risk Case Oversight

• Manage cases involving repeated EVV non-compliance, including members at risk of PCA program termination.
• Ensure appropriate member notification, care planning, and alternative service discussions.
  
  

Appeals, Grievances & Continuous Improvement

• Serve as EVV subject matter expert for Appeals and Grievances.
• Analyze EVV trends and recommend workflow and system improvements
  
  

Qualifications

Education

Graduate from an accredited school of nursing, associate’s degree required, bachelor’s or higher highly preferred

License/Certifications

• Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:
• Must possess a valid drivers’ license
• Must attest to no disqualifiers per Driver Safety Policy
• Must possess and provide proof of minimal state required auto insurance
• Must have reliable transportation
  

Experience

• Minimum of two years of progressive experience in Personal Care Attendant programs, consumer-directed services, Medicaid operations, or Long-Term Services and Supports (LTSS).
• Demonstrated experience with EVV systems, compliance monitoring, and regulatory implementation strongly preferred.
• Experience managing complex member cases, non-compliance, and service terminations.
• Prior supervisory, project management, or program leadership experience recommended.
  
  

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.