Behavioral Health Care Manager

Family Health Center of Worcester, Inc.; Worcester (MA); On-site; USD 65,000 - 90,000; Full time

Job summary

Family Health Center of Worcester, Inc. is seeking a Behavioral Health Care Manager to join the care management team in Worcester, MA.

The CM will work with individuals with complex behavioral health needs, employing outreach methods in various settings including the health center, community, home, or inpatient facilities. The role requires flexibility, creativity, and collaboration with the integrated care team, with responsibilities ranging from comprehensive assessments to education,

Qualifications

• Experience in patient-centered outreach and behavioral health services.
• Ability to perform needs assessment and provide ongoing support.
• Master's degree required; licensure as LCSW/LICSW or LMHC preferred.

Responsibilities

• Conduct Comprehensive Clinical Assessments.
• Engage members and caregivers in care planning.
• Assess member knowledge of conditions; provide education and self-management support.
• Develop and monitor self-management plans with members.
• Coordinate care with primary care teams and pharmacists.
• Provide or facilitate appropriate follow-up and referrals.
• Support care transitions and follow-ups for complex cases.
• Document in EHRs and participate in care team meetings.

Skills

Care coordination

Motivation interviewing

Patient-centered outreach

Education and coaching

Education

MSW or related

LCSW/LICSW or LMHC license

Job description

As an integral member of the care management team the Behavioral Health (BH) Care Manager (CM) will have the opportunity to make a profound impact on the lives of individuals living with complex and/ or chronic Behavioral Health conditions, many of whom also face multiple barriers in their lives which makes it difficult for them to achieve the self-care required to improve their health and well-being. This position requires flexibility, creativity, and may vary from day-to-day to meet members where they are. Outreach methods may vary and may include telephonic or in person in a variety of potential settings such as but not limited to, the health center, community, home, or inpatient facility.

Essential Duties and Responsibilities:

• Conducts Comprehensive Clinical Assessments
• Engages members and care givers in active care planning with a focus on medical, behavioral, social, member-centered care needs. Coaches and guides member/representative to meet bio/psycho/social care goals.
• Assess the member’s knowledge of their medical, behavioral health, and/or social conditions and provides education and self-management support based on the member’s needs and preferences.
• Work with the member to develop a self-management plan
• Coordinate care with the member's providers such as the primary care team, facilitate medication reconciliation with pharmacist, RN and/or primary care team.
• Provide care coordination, which may include but is not limited to facilitating care transitions, supporting the completion of referrals, and/or providing or confirming appropriate follow-up.
• Manage treatment access and follow up with members with coexisting medical and behavioral disorders
• Use motivation interviewing and coaching to help patients to increase their motivation and commitment to change their behavior and to strengthen their motivation for and movement toward a specific goal.
• Participates in the integrated care team meetings and rounds as required.
• Maintain accurate, timely documentation in electronic systems including health center Electronic Health Records (EHRs)
• Other duties as assigned.

Qualifications and Education Requirements:

Education and Experience:

Licensed Clinical Social Worker (LCSW or LICSW), or Licensed Mental Health Counselor (LMHC). Master’s Degree in Psychology, Social Work, or related field preferred.

Minimum 2-5 years of experience providing patient-centered outreach, behavioral health services, needs assessment and support.

Reports to the Director of Care Management