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Fallon Health · 1 day ago

ACO Behavioral Health Case Manager - Chelmsford

US-MA-Lowell

Full-time

Onsite

Mid Level

$88K/yr - $92K/yr

Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. They are seeking an ACO Behavioral Health Case Manager to be part of an interdisciplinary team focused on care coordination, management, and improving access to quality care for members. The role involves conducting assessments, managing member care, and collaborating with various stakeholders to ensure effective service provision.

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Responsibilities

Telephonically assesses and case manages a member panel

May conduct in home face to face visits for onboarding new enrollees and reassessing members, utilizing a variety of interviewing techniques, including motivational interviewing, and employs culturally sensitive strategies to assess a Member’s clinical/functional status to identify ongoing special conditions and develops and implements an individualized, coordinated care plan, in collaboration with the member, the Clinical Integration team, and Primary Care Providers, Specialist and other community partners, to ensure a cost effective quality outcome

Performs Care Transitions Assessments – per Program and product line processes

Maintains up to date knowledge of Program and product line benefits, Plan Handbook Benefits and Coverage details, and department policies and processes and follows policies and processes as outlined to be able to provide education to members and providers; performing a member advocacy and education role including but not limited to member rights

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

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

Assesses the Member’s knowledge about the management of current disease processes and medication regimen, provides teaching to increase Member/caregiver knowledge, and works with the members to assist with learning how to self-manage his or her health needs, social needs or behavioral health needs

Collaborates with appropriate team members to ensure health education/disease management information is provided as identified

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

Ensures members/PRAs participate in the development and approval of their care plans in conjunction with the interdisciplinary primary care team

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

Supports Quality and Ad-Hoc campaigns

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

With member/authorized representative(s) collaboration develops member centered care plans by identifying member care needs while completing program assessments and working with the member to approve their care plan

Manages ACO members in conjunction with the Nurse Case Manager, Navigator, Social Care Managers, ACO Partners, Community Partners, Behavioral Health Partners and others involved/authorized in the member’s care

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

Works collaboratively with Fallon Health Pharmacist, referring members in need of medication review based upon Program process

Develops and fosters relationships with members, family, caregivers, PRAs, vendors and providers to ensure good collaboration and coordination by streamlining 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

Actively participates in clinical rounds

Ensures timely filing with the appropriate Protective Services agency regarding any concerns about the safety and well being of a member

Maintains an ongoing awareness of community clinical, psychiatric, and other outpatient resources as well as state and federal resources as needed

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

Demonstrates positive customer service actions and takes responsibility to ensure member and provider requests and needs are met

Completes Program Assessments, Notes, Screenings, and Care Plans in the TruCare and Provider EMR systems according to Program policies and processes

Serves as a behavioral health consultant to the Fallon Health Clinical Integration Team

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

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

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

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

Performs other responsibilities as assigned by the Manager/designee

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

Qualification

LCSWBehavioral Health AssessmentsCare CoordinationCase Management CertificationMotivational InterviewingCommunity Resources KnowledgeMicrosoft OfficeInterdisciplinary TeamworkMember AdvocacyEffective Communication

Required

Master's degree from an accredited school of social work, mental health counseling, psychology, or human services required

Active, unrestricted license as a LCSW, LICSW or LMHC; reliable transportation

Satisfactory Criminal Offender Record Information (CORI) results

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