Medicare/Community Care Behavioral Health Case Manager
Fallon Health · Worcester, MA · 1 mo ago
OTHRFull-time
We need to output HTML fragment with headings for sections present: About us? The instructions: use
for sections present: About us? The instructions: use for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). We should not repeat job title as heading. The posting includes "Overview About us:" then "Brief Summary Of Purpose". Then "Responsibilities Primary Job Responsibilities". Then "Qualifications Education ...". Also there is "Licenses/Certifications", "Experience". Also "Demonstrates Proficiency Including But Not Limited To". That could be considered Skills. Also there is EEO boilerplate which we must remove. Also there is no explicit Pay, Schedule, Benefits. So we should not create those sections.
We need to preserve all substantive information. Remove boilerplate: EEO statement at end. Also maybe "Fallon Health provides equal employment opportunities..." remove.
Also remove duplicated lines? Not many.
We need to structure sections: maybe "About us" as About us
with paragraph(s). Then "Brief Summary Of Purpose" as Brief Summary Of Purpose
. Then "Responsibilities" as Responsibilities
with - items. Then "Qualifications" as
Qualifications
with subparts? Could break into Education, Licenses/Certifications, Experience, Demonstrates Proficiency (Skills). But instructions: use headings for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we can map: About us -> About us (maybe not exactly but okay). Brief Summary Of Purpose could be considered "About the role". But we can still use heading for that. Responsibilities as heading. Qualifications as heading. Skills as heading for Demonstrates Proficiency. We should not create Requirements separate if not present; but Qualifications covers.
We need to preserve all substantive info: include details about responsibilities list items. We'll need to extract each responsibility bullet from the long paragraph. The responsibilities section is a long paragraph with many sentences separated by semicolons. We need to turn each into - . Must not invent or summarize away detail. So we need to split the responsibilities text into distinct items. Let's parse.
Responsibilities section text (starting after "Responsibilities 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 assessment(s) 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 Clinical Intergration Leadership Team Clinical documentation and data management and reporting Documents outcomes of initial and follow up home visits in the documentation system per department guidelines ensuring all Care Team 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 Care Team members and relevant caregivers are aware of referrals and goals. Documents all activity in the documentation system per department guidelines Completes/facilitates referrals for needed neuropsychiatric evaluation(s) notifying all Care Team team members of evaluation referral and documenting referral activity in the documentation system Monitors daily inpatient BH census log and contacts appropriate hospital staff to provide care coordination (as long as member has not restricted the facility to share information with Fallon). Within one business day ensures notification of member’s psychiatric admission and forwards information to Care Team members for care coordination. Documents all activity in the documentation systemper department guidelines Reviews all of the medications at initial and follow-up assessments with members and forward results to the Nurse Case Manager or PCP as indicated. Documents all activity per department guidelines Initiates and updates Care Plan in the documentation system on all active members in the BHCM panel per Care Plan Process for products per workflows and requirements Completes daily tasks/ outreach to members and identifies appropriate assessments to be completed within timelines Monitors compliance Strictly observes HIPAA regulations and Fallon Health’s policies regarding confidentiality of member information Strictly observes safety awareness and home visit process when conducting home visits Complies with all reporting requirements and processes as applicable 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 Provides training and consultation 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 Carelon to ensure that contracted behavioral health providers are knowledgable about the plan benefits, eligibility requirements, and care coordination and communication needs Coordinate with Carelon staff to ensure quality and timely arrangement of necessary mental health and substance use supports. Attends Fallon Health/Carelon 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 Attends and participates in team’s medical rounds case presentations"
We need to split into logical bullet points. Could be many. We'll try to capture each distinct responsibility.
Let's break by sentences (period). But some sentences are long with semicolons. We'll split by semicolon and period.
I'll create list items:
- Contact 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 and social care needs of the members.
- Recommend modifications to the member’s integrated care plan if present.
- Complete telephonic initial and follow-up assessments after all BH hospitalizations/transitions of care.
- Complete telephonic visits to assist members with applications for indicated government and community programs including SNAP, housing, prescription assistance, etc.
- Maintain an ongoing awareness of clinical, social, and financial resources available in the community as well as state/federal and national resources.
- Coordinate and work with governmental, private, civic, religious, business and/or other groups to arrange and coordinate plans for members served in the program.
- Assist members in establishing or reinforcing a social support network, thereby reducing their dependence on the medical system.
- Offer proactive review of members for multidisciplinary care planning with PCPs and care teams.
- Support the care teams in the development, implementation, and modification of individualized care plans for members; attend care team meetings.
- Update all relevant care team members regarding the member’s mental health and substance use status and develop and/or propose changes to the behavioral health care plan as appropriate.
- Participate in monthly supervision with leader.
- Perform other responsibilities as assigned by Clinical Integration Leadership Team.
- Document outcomes of initial and follow-up home visits in the documentation system per department guidelines, ensuring all care team members are notified of any emergent needs and data entry completed immediately.
- Complete referrals for all the member’s recommended behavioral health services, including outpatient supports, therapy, and medication management/assessment; ensure all care team members and relevant caregivers are aware of referrals and goals.
- Document all activity in the documentation system per department guidelines.
- Complete/facilitate referrals for needed neuropsychiatric evaluation(s), notifying all care team members of evaluation referral and documenting referral activity in the documentation system.
- Monitor daily inpatient BH census log and contact appropriate hospital staff to provide care coordination (as long as member has not restricted the facility to share information with Fallon).
- Within one business day, ensure notification of member’s psychiatric admission and forward information to care team members for care coordination.
- Document all activity in the documentation system per department guidelines.
- Review all medications at initial and follow-up assessments with members and forward results to the nurse case manager or PCP as indicated.
- Document all activity per department guidelines.
- Initiate and update care plan in the documentation system on all active members in the BHCM panel per care plan process for products per workflows and requirements.
- Complete daily tasks/outreach to members and identify appropriate assessments to be completed within timelines.
- Monitor compliance.
- Strictly observe HIPAA regulations and Fallon Health’s policies regarding confidentiality of member information.
- Strictly observe safety awareness and home visit process when conducting home visits.
- Comply with all reporting requirements and processes as applicable.
- Ensure timely filing with the appropriate protective services agency regarding any concerns about the safety and well-being of a member.
- Maintain an ongoing awareness of community clinical, psychiatric, and other outpatient resources as well as state and federal resources as needed.
- Provide training and consultation.
- Serve as a behavioral health consultant to the Fallon Health Clinical Integration Team.
- Offer recommendations to continued program development and be an active participant in suggesting opportunities to enhance the program.
- Work with Fallon Health Provider Relations and Carelon to ensure that contracted behavioral health providers are knowledgeable about the plan benefits, eligibility requirements, and care coordination and communication needs.
- Coordinate with Carelon staff to ensure quality and timely arrangement of necessary mental health and substance use supports.
- Attend Fallon Health/Carelon meetings when requested.
- Attend supervision and 1:1 meetings with leader.
- Attend team huddles, staff meetings, site meetings and other Fallon Health and business-related meetings as required (in person or telephonic depending upon need).
- Attend and participate in team’s medical rounds case presentations.
That's a lot but okay.
Now Qualifications section: includes Education, Licenses/Certifications, Experience, Demonstrates Proficiency (Skills). We'll create
Qualifications
and inside maybe subheadings? But instructions only allow for section headings; we could still use
for subparts. We'll keep as
- for each bullet.
Education: "Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required."
Licenses/Certifications: "License: Active, unrestricted license as a LICSW, LMHC or equivalent; reliable transportation Certification : Certification in Case Management plus 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 government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred."
Demonstrates Proficiency Including But Not Limited To: list of abilities.
We'll treat that as Skills section maybe
Skills
with - .
But we already have Qualifications heading; we could include Education, Licenses/Certifications, Experience as
or
. Then Skills separate.
Let's do:
Qualifications
Education: Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required.
Licenses/Certifications: Active, unrestricted license as a LICSW, LMHC or equivalent; reliable transportation. Certification in Case Management. Satisfactory Criminal Offender Record Information (C
About us
with paragraph(s). Then "Brief Summary Of Purpose" asBrief Summary Of Purpose
. Then "Responsibilities" asResponsibilities
with- items. Then "Qualifications" as
Qualifications
with subparts? Could break into Education, Licenses/Certifications, Experience, Demonstrates Proficiency (Skills). But instructions: use headings for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. So we can map: About us -> About us (maybe not exactly but okay). Brief Summary Of Purpose could be considered "About the role". But we can still use heading for that. Responsibilities as heading. Qualifications as heading. Skills as heading for Demonstrates Proficiency. We should not create Requirements separate if not present; but Qualifications covers. We need to preserve all substantive info: include details about responsibilities list items. We'll need to extract each responsibility bullet from the long paragraph. The responsibilities section is a long paragraph with many sentences separated by semicolons. We need to turn each into - . Must not invent or summarize away detail. So we need to split the responsibilities text into distinct items. Let's parse.
Responsibilities section text (starting after "Responsibilities 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 assessment(s) 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 Clinical Intergration Leadership Team Clinical documentation and data management and reporting Documents outcomes of initial and follow up home visits in the documentation system per department guidelines ensuring all Care Team 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 Care Team members and relevant caregivers are aware of referrals and goals. Documents all activity in the documentation system per department guidelines Completes/facilitates referrals for needed neuropsychiatric evaluation(s) notifying all Care Team team members of evaluation referral and documenting referral activity in the documentation system Monitors daily inpatient BH census log and contacts appropriate hospital staff to provide care coordination (as long as member has not restricted the facility to share information with Fallon). Within one business day ensures notification of member’s psychiatric admission and forwards information to Care Team members for care coordination. Documents all activity in the documentation systemper department guidelines Reviews all of the medications at initial and follow-up assessments with members and forward results to the Nurse Case Manager or PCP as indicated. Documents all activity per department guidelines Initiates and updates Care Plan in the documentation system on all active members in the BHCM panel per Care Plan Process for products per workflows and requirements Completes daily tasks/ outreach to members and identifies appropriate assessments to be completed within timelines Monitors compliance Strictly observes HIPAA regulations and Fallon Health’s policies regarding confidentiality of member information Strictly observes safety awareness and home visit process when conducting home visits Complies with all reporting requirements and processes as applicable 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 Provides training and consultation 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 Carelon to ensure that contracted behavioral health providers are knowledgable about the plan benefits, eligibility requirements, and care coordination and communication needs Coordinate with Carelon staff to ensure quality and timely arrangement of necessary mental health and substance use supports. Attends Fallon Health/Carelon 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 Attends and participates in team’s medical rounds case presentations"
We need to split into logical bullet points. Could be many. We'll try to capture each distinct responsibility.
Let's break by sentences (period). But some sentences are long with semicolons. We'll split by semicolon and period.
I'll create list items:
- Contact 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 and social care needs of the members.
- Recommend modifications to the member’s integrated care plan if present.
- Complete telephonic initial and follow-up assessments after all BH hospitalizations/transitions of care.
- Complete telephonic visits to assist members with applications for indicated government and community programs including SNAP, housing, prescription assistance, etc.
- Maintain an ongoing awareness of clinical, social, and financial resources available in the community as well as state/federal and national resources.
- Coordinate and work with governmental, private, civic, religious, business and/or other groups to arrange and coordinate plans for members served in the program.
- Assist members in establishing or reinforcing a social support network, thereby reducing their dependence on the medical system.
- Offer proactive review of members for multidisciplinary care planning with PCPs and care teams.
- Support the care teams in the development, implementation, and modification of individualized care plans for members; attend care team meetings.
- Update all relevant care team members regarding the member’s mental health and substance use status and develop and/or propose changes to the behavioral health care plan as appropriate.
- Participate in monthly supervision with leader.
- Perform other responsibilities as assigned by Clinical Integration Leadership Team.
- Document outcomes of initial and follow-up home visits in the documentation system per department guidelines, ensuring all care team members are notified of any emergent needs and data entry completed immediately.
- Complete referrals for all the member’s recommended behavioral health services, including outpatient supports, therapy, and medication management/assessment; ensure all care team members and relevant caregivers are aware of referrals and goals.
- Document all activity in the documentation system per department guidelines.
- Complete/facilitate referrals for needed neuropsychiatric evaluation(s), notifying all care team members of evaluation referral and documenting referral activity in the documentation system.
- Monitor daily inpatient BH census log and contact appropriate hospital staff to provide care coordination (as long as member has not restricted the facility to share information with Fallon).
- Within one business day, ensure notification of member’s psychiatric admission and forward information to care team members for care coordination.
- Document all activity in the documentation system per department guidelines.
- Review all medications at initial and follow-up assessments with members and forward results to the nurse case manager or PCP as indicated.
- Document all activity per department guidelines.
- Initiate and update care plan in the documentation system on all active members in the BHCM panel per care plan process for products per workflows and requirements.
- Complete daily tasks/outreach to members and identify appropriate assessments to be completed within timelines.
- Monitor compliance.
- Strictly observe HIPAA regulations and Fallon Health’s policies regarding confidentiality of member information.
- Strictly observe safety awareness and home visit process when conducting home visits.
- Comply with all reporting requirements and processes as applicable.
- Ensure timely filing with the appropriate protective services agency regarding any concerns about the safety and well-being of a member.
- Maintain an ongoing awareness of community clinical, psychiatric, and other outpatient resources as well as state and federal resources as needed.
- Provide training and consultation.
- Serve as a behavioral health consultant to the Fallon Health Clinical Integration Team.
- Offer recommendations to continued program development and be an active participant in suggesting opportunities to enhance the program.
- Work with Fallon Health Provider Relations and Carelon to ensure that contracted behavioral health providers are knowledgeable about the plan benefits, eligibility requirements, and care coordination and communication needs.
- Coordinate with Carelon staff to ensure quality and timely arrangement of necessary mental health and substance use supports.
- Attend Fallon Health/Carelon meetings when requested.
- Attend supervision and 1:1 meetings with leader.
- Attend team huddles, staff meetings, site meetings and other Fallon Health and business-related meetings as required (in person or telephonic depending upon need).
- Attend and participate in team’s medical rounds case presentations.
That's a lot but okay.
Now Qualifications section: includes Education, Licenses/Certifications, Experience, Demonstrates Proficiency (Skills). We'll create
Qualifications
and inside maybe subheadings? But instructions only allowfor section headings; we could still use
for subparts. We'll keep as
- for each bullet.
Education: "Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required."
Licenses/Certifications: "License: Active, unrestricted license as a LICSW, LMHC or equivalent; reliable transportation Certification : Certification in Case Management plus 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 government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred."
Demonstrates Proficiency Including But Not Limited To: list of abilities.
We'll treat that as Skills section maybe
Skills
with- .
But we already have Qualifications heading; we could include Education, Licenses/Certifications, Experience as
or
- . Then Skills separate.
Let's do:
Qualifications
Education: Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required.
Licenses/Certifications: Active, unrestricted license as a LICSW, LMHC or equivalent; reliable transportation. Certification in Case Management. Satisfactory Criminal Offender Record Information (C
- .
But we already have Qualifications heading; we could include Education, Licenses/Certifications, Experience as
- for each bullet.
Education: "Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required."
Licenses/Certifications: "License: Active, unrestricted license as a LICSW, LMHC or equivalent; reliable transportation Certification : Certification in Case Management plus 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 government programs, community resources, case management, substance use disorders and/or severe and persistent mental illness preferred."
Demonstrates Proficiency Including But Not Limited To: list of abilities.
We'll treat that as Skills section maybe