Medicare​/Community Care Behavioral Health Case Manager - LICSW or LMHC req'd

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.

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Brief summary of purpose

The Behavioral Health Case Manager (BHCM) is responsible for assessing a member’s behavioral and social care needs and developing and implementing a care plan to address all identified issues. The BHCM serves as an active participant on the member’s Care Team and an advocate for the members. The BHCM is actively involved with the member from time of psychiatric admission through discharge and ensures all Care Team members and healthcare providers are aware of member’s status.

The BHCM facilitates prompt access to outpatient mental health support, and community resources. The BHCM collaborates and works with members of the care team at both Fallon Health and community resources (Partners) during period of member transition of care.

May attend telephonic meetings, care coordination meetings, partner communication meetings, and other meetings with providers, partners, and members to perform assessments, train staff, coordination communication and otherwise represent Fallon Health in a positive way.

Primary Job Responsibilities

Assessment and care plan coordination

• Contacts Members and Caregivers/guardians telephonically and/or in person after receiving a BH referral to:
  • Conduct behavioral health assessments and administer other assessment tools as indicated;
  • Assess and address the mental health and social care needs of the members;
  • Recommend modifications to the member’s integrated care plan if present
• Completes telephonic initial and follow up assessments after all BH hospitalizations/Transitions of Care
• Completes telephonic visits to assist members with applications for indicated government and community programs including SNAP, housing, prescription assistance, etc.

• Maintains an ongoing awareness of clinical, social, and financial resources available in the community as well as State/Federal and national resources
• Coordinates and works with governmental, private, civic, religious, business and/or other groups to arrange and coordinate plans for members served in the Program
• Assists members in establishing or reinforcing a social support network, thereby reducing their dependence on the medical system.

• Offers proactive review of members for multidisciplinary care planning with PCPs and Care Teams
• Supports the Care Teams in the development, implementation and modification of Individualized Care Plans for Members, attends Care Team team meetings
• Updates all relevant Care Team members regarding the member’s mental health and substance use status and develops and/or proposes changes to the behavioral health care plan as appropriate
• Participates in monthly supervision with leader
• Performs other responsibilities as assigned by…