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Fallon Health · 2 weeks ago

Substance Abuse / SUD Care Manager - LCSW, LICSW, LMHC or LADC preferred - Hybrid

US-MA-Worcester

Full-time

Hybrid

Mid Level

$90K/yr - $100K/yr

3+ years exp

Fallon Health is a company that prioritizes its members by delivering equitable, high-quality care. The SUD Care Manager is responsible for ensuring seamless coordination of care for members with substance use disorder needs, acting as a liaison among various care teams and facilities to promote integrated care and improve member outcomes.

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Responsibilities

Conduct a daily review of SUD Census reports and disseminate member-level information to assigned Fallon Care teams

Collaborate with clinical teams of assigned SUD providers on treatment plans and discharge planning of members on inpatient units and boarding in emergency departments to assist in transition to community

Works collaboratively and cohesively with all members of the care team (both internal and external staff and providers)

Collaborates with the interdisciplinary team in identifying and addressing high risk members

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 members, family, caregivers, and/or authorized representatives

Provide consultation and education regarding SUD clinical programs to ACO Partners, Fallon Care Management teams and primary care settings

Act as primary liaison with SUD facilities at all levels of care and community providers to assist with treatment planning as needed

Works with Fallon Health Provider Relations and Carelon to ensure that contracted SUD providers are knowledgeable about the plan benefits, eligibility requirements, and care coordination and communication needs

Monitor SUD HEDIS measures and identify opportunities for improvement

Act as a liaison with BH/SUD quality team

Offers recommendations to continued program development and is an active participant in suggesting opportunities to enhance the program

Develops workflows and educates Team on workflows as appropriate

Strictly observes HIPAA regulations and the Fallon Health policies regarding confidentiality of member information

Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives

Performs other responsibilities as assigned by the Clinical Manager/designee

Act as a subject matter expert in federal/state/community entitlement and other benefit programs keeping up to date with current guidelines and program availability, access details and other pertinent details associated with eligibility and obtainment

Maintains an ongoing awareness of clinical, social, and financial resources available in the community

Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners

Qualification

LCSW/LICSW/LMHC licenseSUD program knowledgeCase management experienceHEDIS measures knowledgeHIPAA regulations familiarityCulturally appropriate careCommunity resource navigationEducation in social workCommunication skillsCollaboration skills