Behavioral Health Care Partner: Care Coordinator

UMass Med School; Westborough (MA); On-site; USD 60,000 - 70,000; Full time

Job summary

UMass Chan Medical School seeks a Behavioral Health Care Partner Care Coordinator to manage PASRR-based caseloads in nursing facilities across the MetroWest MA focus area. You will conduct regular visits, document carefully, and coordinate PASRR services to support residents toward community living.

The role requires collaboration with guardians, facility staff, and state agencies, plus travel across the state as needed. A relevant degree or LPN license with clinical experience is required.

Qualifications

• Bachelor's degree in social work or related health and human services field is required.
• LPN with an Associate's Degree or equivalent is required.
• 2 years of direct service, care coordination, or case management experience with adults with psychiatric disabilities, including 1 year in medical/clinical setting.
• Experience with social service/rehabilitation systems and ability to travel statewide with a valid driver's license.
• Proficient in Microsoft Office applications (Word, Outlook, databases).

Responsibilities

• Serve as a care coordinator for an assigned caseload of nursing facility residents.
• Conduct monthly visits with residents and guardians, with at least one in-person visit per quarter.
• Document information in data systems per guidelines.
• Participate in quarterly nursing care planning meetings.
• Advocate for residents to ensure needs are met.
• Ensure PASRR services are delivered to residents.
• Identify gaps and propose innovative program solutions.
• Monitor clinical appropriateness of facility and community supports.
• Escalate concerns to oversight authorities.
• Assist in transition planning to community living when applicable.
• Maintain records of encounters in data systems.
• Assist in preparing statistics and resource data requests.
• Foster partnerships with healthcare providers and facilities.
• Participate in public relations and conferences as needed.
• Maintain relationships with participants and providers; protect confidentiality per HIPAA.
• Support performance improvement and quality initiatives.
• Comply with department policies and safety regulations.

Skills

Care coordination

Medical terminology

Microsoft Office

Education

Bachelor's degree in social work or related field

Licensed Practical Nurse (LPN) with an Associate's Degree

Tools

Microsoft Word

Outlook

Database systems

Job description

UMass Chan Medical School seeks a Behavioral Health Care Partner Care Coordinator to manage PASRR-based caseloads in nursing facilities across the MetroWest MA focus area. You will conduct regular visits, document carefully, and coordinate PASRR services to support residents toward community living.

The role requires collaboration with guardians, facility staff, and state agencies, plus travel across the state as needed. A relevant degree or LPN license with clinical experience is required.