ACO Behavioral Health Case Manager

About the role

Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation's top health plans for member experience and service and clinical quality.

The Accountable Care Organization (ACO) Behavioral Health Case Manager I (BHCM I) is an integral part of an interdisciplinary team focused on transition of care assessment and support, care coordination, care management, and improving access to and quality of care for Fallon Health ACO members. The BHCM I embeds in ACO Partner Provider Offices and works closely with ACO Partner Providers, office staff, care management staff, and others at partner sites managing member care. The BHCM I seeks to establish telephonic and/or face-to-face relationships with the member/caregiver(s) to better ensure ongoing service provision and care coordination, consistent with the member-specific care plan developed by the BHCM I and care team. Responsibilities may include conducting in-home/office face-to-face visits for members identified as needing face-to-face interaction and assessments, with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources. The BHCM I conducts assessments and refers members to Community Partner Programs such as Behavioral Health and Long-Term Services and Supports, and may refer members to the Flex Program as applicable depending upon the ACO affiliation. The BHCM I may also utilize an ACD line to support department and incoming/outgoing calls with the goal of first-call resolution.

Responsibilities

Member Assessment & Education

• Conduct telephonic and in-home assessments; create individualized care plans with members and care teams.
• Perform care transition assessments and maintain knowledge of program benefits and policies.
• Educate members/caregivers on disease management and self-care.
• Advocate for members to access benefits and community resources (e.g., housing, food, transportation).

Care Coordination & Collaboration

• Develop member-centered care plans and monitor progress toward goals.
• Coordinate with Nurse Case Managers, Navigators, Social Care Managers, and community partners.
• Foster relationships with members, families, and providers to ensure timely, cost-effective care.
• Participate in clinical rounds and report safety concerns to Protective Services as needed.

Provider & Regulatory Responsibilities

• Attend care plan meetings and provider visits; lead reviews when applicable.
• Complete assessments, notes, and care plans in TruCare and EMR systems.
• Serve as a behavioral health consultant and provide training as needed.
• Collaborate with Fallon Health, Beacon Health Options, and contracted providers to ensure timely mental health and substance use supports.
• Maintain HIPAA compliance and attend required meetings and supervision.

Other

• Support quality initiatives and department projects.
• Cover assignments as needed and perform other duties as directed.

Qualifications

Education

• Master's degree from an accredited school of social work, mental health counseling, or psychology.

License

• LCSW, or Master's MA/MS in Mental Health Counseling under clinical supervision.

Certification

• Certification in Case Management a plus.

Other Requirements

• Satisfactory Criminal Offender Record Information (CORI) results.
• Compliance with ACO Partner Health and Educational requirements.

Experience

• Four or more years clinical experience in the behavioral health/mental health setting required.
• Experience with government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred.

Performance Requirements

• Ability to conduct behavioral health assessments, develop and implement comprehensive care plans that address 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.

Pay

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $82,000 - $92,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate's experience, skills, and fit with the role's responsibilities.