BHCP Care Coordinator (2026-52279)

UMass Chan; Westborough (MA); On-site; USD 65,000 - 90,000; Full time

Job summary

UMass Chan Medical School seeks a Behavioral Health Care Partner (BHCP) Care Coordinator to manage a caseload of nursing facility residents identified via PASRR and ensure delivery of recommended services. The role includes visits, documentation, and active care planning to support transition to community living where possible.

You will advocate for residents, address gaps with innovative programs, coordinate with providers, and uphold HIPAA and quality-improvement initiatives within a

Qualifications

• Bachelor’s degree in social work or related health and human services field.
• OR Licensed Practical Nurse (LPN) with an associate degree.
• Two years of work experience providing direct service, care coordination, or case management to adults with psychiatric disabilities, including at least one year in a medical/clinical setting.
• Demonstrated knowledge of social service/rehabilitation systems; ability to travel statewide; proficient in MS Word/Outlook/databases.

Responsibilities

• Serve as a care coordinator for an assigned caseload of nursing facility residents.
• Conduct monthly in-person or virtual visits with residents and guardians; at least one in-person per quarter.
• Review and document relevant information into data systems per guidelines.
• Participate in quarterly nursing care planning meetings with the nursing facility.
• Advocate for residents to ensure their needs are met and services are delivered.
• Identify service gaps and develop solutions through innovative programming.
• Monitor clinical appropriateness of facility and community supports; address issues.
• Escalate concerns to proper oversight authorities as needed.
• Contribute to transition planning to community living when applicable.
• Maintain records of encounters in data systems per guidelines.
• Support in preparing/responding to statistics and data requests.
• Foster partnerships with providers, hospitals, long-term care facilities, and programs.
• Participate in public relations, conferences, and meetings as needed.
• Maintain HIPAA-compliant confidentiality and follow department policies and safety rules.
• Contribute to performance improvement and quality initiatives.

Education

Bachelor's degree in social work or related health field

Licensed Practical Nurse (LPN) with an Associate degree

Job description

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When you join the UMass Chan Medical School team, you join us in advancing together to improve the health and well-being of our diverse communities throughout Massachusetts and across the US and the world.Together, we lead in education, research, health care delivery, and public service. Your life’s work is more than a career. It’s an expression of your passion, intellect, skill, and drive.UMass Chan's commitment to excellence, innovation, competitive benefits, and work-life integration will allow you to build a professionally rewarding career as we work together to better or improve the health of people around the globe.

Under the general supervision of the Associate Director, or designee, the Behavioral Health Care Partner (BHCP) Care Coordinator is responsible for completing and managing a caseload of nursing facility residents who have been identified through the Preadmission Screening and Resident Review (PASRR). This position ensures that nursing facility residents with confirmed serious mental illness (SMI) receive all recommended PASRR services and supports, and for those residents who are interested, monitoring the progress towards community living.

Responsibilities

• Serve as a care coordinator for an assigned caseload of nursing facility residents.
• Conduct monthly in-person or virtual visits with each nursing facility resident and guardians, if applicable with at least one in-person visit per quarter
• Review and document all relevant information including written clinical summaries into data system applications in accordance with program guidelines and regulations.
• Participate in quarterly nursing care planning meetings with the nursing facility.
• Act as an advocate for assigned nursing facility residents to ensure their needs are being met.
• Ensure all recommended PASRR services are delivered to assigned nursing facility residents.
• Identify service gaps and solutions to gaps through innovative programming
• Monitor the clinical appropriateness of the residents facility and community-based supports and address issues accordingly
• Escalate concerns with the residents care to the proper oversight authority(s)
• Act as an active member of the residents transition planning to community living; if applicable
• Maintain individual records documenting all applicant/participant encounters and contacts into data system applications in accordance with program guidelines and regulations.
• Support in the preparation and responses to requests for statistics and resource/service data
• Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals, long term care facilities and other programs/organizations involved in the provision of services
• Participate in public relations efforts, attending conferences and meetings as needed
• Maintain positive working relationships with applicant/participants, and relevant informal supports, provider organizations, program consultants and state agencies
• Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations
• Participate in performance improvement initiatives and demonstrate the use of quality improvement in daily operations
• Comply with established departmental policies, procedures and objectives
• Comply with all health, safety and program regulations and requirements

Qualifications

• Bachelors Degree in social work; a related health and human services field or equivalent.

OR

• A Licensed Practical Nurse (LPN) with an Associates Degree or equivalent.

AND

• 2 years of work experience providing direct service, care coordination, or case management to adults with psychiatric disabilities, inclusive of 1 year of experience in a medical or clinical setting with knowledge of medical terminology.
• Demonstrated knowledge and experience with relevant social service/rehabilitation systems.
• Ability to travel statewide with a valid drivers license
• Proficient in the use of Microsoft Applications, including Word, Outlook and database

METROWEST MA FOCUS AREA

Posting Disclaimer:

This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list.Duties and expectations may evolve in response to the needs of the department and the broader institution.

In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement).At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience.We also consider internal equity to ensure fair and consistent compensation across our teams.

Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.

In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.

UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.