Behavioral Health Care Navigator for ACO Teams

Fallon Community Health Plan, Inc.; Worcester (MA); On-site; USD 82,000 - 83,000; Full time

Job summary

Fallon Health in Worcester, MA is seeking an Accountable Care Organization Behavioral Health Case Manager I to join an interdisciplinary team focused on transition of care, care coordination, and improving access to high-quality behavioral health services for Fallon Health ACO members.

The BHCM I conducts assessments, develops care plans with the care team, educates members and caregivers, coordinates with nurses, social care managers and community partners, and helps ensure timely,

Qualifications

• Master’s degree in social work, mental health counseling, or psychology.
• LCSW or MA/MS in Mental Health Counseling under clinical supervision.
• CORI clearance and compliance with ACO partner requirements.

Responsibilities

• Conduct telephonic and in-home assessments; create individualized care plans with members and care teams.
• Perform care transition assessments and educate members and caregivers on disease management.
• Coordinate with Nurse Case Managers, Navigators, Social Care Managers, and community partners.
• Lead and attend care plan meetings; document assessments, notes and plans in TruCare and EMR systems.
• Ensure timely behavioral health and substance use supports while maintaining HIPAA compliance.

Skills

BH care coordination

Care management

Social work

Education

Master’s degree in social work, mental health counseling, psychology

Tools

TruCare EMR

Microsoft Office

Job description

Fallon Health in Worcester, MA is seeking an Accountable Care Organization Behavioral Health Case Manager I to join an interdisciplinary team focused on transition of care, care coordination, and improving access to high-quality behavioral health services for Fallon Health ACO members.

The BHCM I conducts assessments, develops care plans with the care team, educates members and caregivers, coordinates with nurses, social care managers and community partners, and helps ensure timely,