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Fallon Health Clinical Integration Behavioral Health Case Manager in Worcester, Massachusetts

Overview

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.

Brief summary of purpose

The Behavioral Health Case Manager (BHCM) is responsible for assessing a member’s behavioral health and developing a treatment plan to address the member’s mental health and/or substance use disorder needs. Serves as an active participant on the member’s Primary Care Team (PCT) and an advocate for the member. The BHCM is actively involved with the member from time of psychiatric admission through discharge and ensures all PCT members and healthcare providers are aware of member’s status. The BHCM facilitates prompt access to outpatient mental health supports, and community resources.

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 assessment(s) and administer other assessment tools as indicated;

  • Assess and address the mental health needs of the members;

  • Recommend modifications to the member’s integrated care plan.

  • Completes a home visit for all agreeable referred Members within alloted time frames and in the event of an emergent mental health need or as indicated behavioral health clinical change (not otherwise accounted for by a medical change) to assign a rating category which determines BH case management level of involvement.

Clinical documentation and data management and reporting

  • Documents outcomes of initial and follow up home visits in the CER per department guidelines ensuring all PCT members are notified of any emergent needs and data entry completed immediately.

  • Completes referrals for all the Member’s recommended behavioral health services, including outpatient supports, therapy, and medication management/assessment; ensures all PCT members and relevant caregivers are aware of referrals and goals. Documents all activity in the CER per department guidelines.

Qualifications

Education

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

License/Certifications

License: Active, unrestricted license as an LICSW and/or LMHC or license-eligible, reliable transportation to be used for home visits

Certification : Certification in Case Management preferred

Other: Satisfactory Criminal Offender Record Information (CORI) results

Experience

A minimum of three years clinical experience in the behavioral health/mental health setting required. Experience with case management, especially substance use disorders and/or severe and persistent mental illness preferred.

Demonstrates proficiency including but not limited to :

  • 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 assist members with relevant food, housing and state applications (e.g. DDS, DMH)

  • Experience with subpopulations including children, adolescents, the homeless, and those with disabilities,

  • Effective case management, care coordination, and member advocacy skills

  • Knowledge about behavioral health community resources, levels of care, criteria for levels of care and the ability to appropriately develop and implement a care plan following regulatory guidelines and level of care criteria

  • Familiarity with motivational interviewing and harm reduction to engage and connect with members

  • Knowledge of severe and persistent mental illness and substance use disorders

  • Ability to work collaboratively with BH vendor

  • Familiarity with software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word

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.

PM16

Location US-MA-Worcester

Posted Date 1 month ago (10/21/2021 1:35 PM)

Job ID 6568

# Positions 1

Category Behavioral Health

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