Elderly Program Behavioral Health Case Manager - LICSW or LMHC
Company: Fallon Community Health Plan
Location: Fall River
Posted on: May 5, 2022
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Job Description:
Elderly Program Behavioral Health Case Manager - LICSW or
LMHCUS-MA-Fall RiverJob ID: 6826Type: Full Time# of Openings:
1Category: Behavioral HealthRecruiting Location - Fall River,
MAOverviewThis Behavioral Health Case Manager covers Fall River to
Framingham to Boston to Cape Cod working mostly from HOME with
ability to do visits in homes when needed. Fallon Health
Vaccination Requirements:To protect the health and safety of our
workforce, members and communities we serve, Fallon Health now
requires all employees to disclose COVID-19 vaccination status. As
of 2/1/2022, all roles not designated as "Remote" require full
COVID-19 vaccination and Fallon Health will obtain the necessary
information from candidates prior to employment to ensure
compliance. Failure to meet the vaccination requirement may result
in rescission of an employment offer or termination of employment.
About Fallon Health:Founded in 1977, Fallon Health is a leading
health care services organization that supports the diverse and
changing needs of those we serve. In addition to offering
innovative health insurance solutions and a variety of Medicaid and
Medicare products, we excel in creating unique health care programs
and services that provide coordinated, integrated care for seniors
and individuals with complex health needs. Fallon has consistently
ranked among the nation's top health plans, and is accredited by
the National Committee for Quality Assurance for its HMO, Medicare
Advantage and Medicaid products. For more information, visit
fallonhealth.org. About NaviCare:Fallon Health is a leader in
providing senior care solutions such as NaviCare, a Medicare
Advantage Special Needs Plan and Senior Care Options program.
Navicare integrates care for adults age 65 and older who are dually
eligible for both Medicare and MassHealth Standard. A personalized
primary care team manages and coordinates the NaviCare member's
health care by working with each member, the member's family and
health care providers to ensure the best possible outcomes. Brief
summary of purpose:The Behavioral Health Case Manager (BHCM) is
responsible for assessing a member's behavioral health and
developing a treatment plan to address the member's mental health
and/or substance use disorder needs. Serves as an active
participant on the member's Primary Care Team (PCT) and an advocate
for the member. The BHCM is actively involved with the member from
time of psychiatric admission through discharge and ensures all PCT
members and healthcare providers are aware of member's status. The
BHCM facilitates prompt access to outpatient mental health
supports, and community resources.ResponsibilitiesAssessment 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
needs of the members; Recommend modifications to the member's
integrated care plan.Completes a home visit for all agreeable
referred Members within alloted time frames and in the event of an
emergent mental health need or as indicated behavioral health
clinical change (not otherwise accounted for by a medical change)
to assign a rating category which determines BH case management
level of involvement.Completes emergent home visits with Members to
assess any reported suicidal/homicidal statements in conjunction
with other members of the Care Team, plans emergent mental health
supports utilizing Community Resources when appropriate and
collaborates with Beacon Health Options for the admission of an
Member to an inpt Psychiatric unit when indicated.Completes home
visits and follow up assessments after all BH
hospitalizations/Transitions of CareCoordinates care between
multiple behavioral health and Primary Care Team providers as
needed including but not limited to State Agencies. Identifies
behavioral health services and care delivery settings and
recommends alternatives when appropriate.Offers proactive review of
members for a multidisciplinary care planning with PCPs and
PCTs.Supports the PCTs in the development, implementation and
modification of Individualized Care Plans for Members, attends PCT
team meetings including those in provider offfices, community
partner locations, office locations and otherwise.Updates all
relevant PCT 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.Works collaboratively
with the outreach team and Fallon ESR employees to assist in the
smooth transition of potential Members who present with a defined
behavioral health need including but not limited to: resources for
medication compliance and appropriate in-network BH
providers.Clinical documentation and data management and
reporting:Documents outcomes of initial and follow up home visits
in the CER per department guidelines ensuring all PCT 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 PCT members and
relevant caregivers are aware of referrals and goals. Documents all
activity in the CER per department guidelines.Completes/facilitates
referrals for needed neuropsychiatric evaluation(s) notifying all
PCT team members of evaluation referral and documenting referral
activity in CER.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 PCT team members
for care coordination. Documents all activity in the CER per
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 in the CER
per department guidelines.Initiates and updates Care Plan in the
CER on all active members in the BHCM panel per Care Plan
Process.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 NaviCare
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 an 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
TeamWorks colaboratively with the Clinical Integration Geriatrician
on clinical care issues.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 Beacon Health Options to ensure that
contracted behavioral health providers are knowledgable about the
plan benefits, eligibility requirements, and care coordination and
communication needs.Coordinate with Beacon staff to ensure quality
and timely arrangement of necessary mental health and substance use
supports.Attends Fallon Health/Beacon meetings when
requested.Attends supervision and 1:1 meetings with Manager.
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 monthly medical rounds case
presentationsQualificationsEducation:Master's degree from an
accredited school of social work, mental health counseling,
psychology, or human services required.
License/Certifications:License: Active, unrestricted license as an
LICSW and/or LMHC or license-eligible, reliable transportation to
be used for home visitsCertification: Certification in Case
Management preferred 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 case management, especially substance use
disorders and/or severe and persistent mental illness preferred.
Demonstrates proficiency including but not limited to:Ability to
conduct behavioral health assessments, develop and implement
comprehensive care plans that addresses the member's behavioral
health needs in conjunction with their medical needs and social
determinants of healthAbility to serve as a member on an
interdisciplinary care team that may include the member's primary
care physician, medical providers, behavioral health providers,
state agencies and/or internal nurse case managers and
navigatorsAbility to assist members with relevant food, housing and
state applications (e.g. DDS, DMH)Experience with subpopulations
including children, adolescents, the homeless, and those with
disabilities, Effective case management, care coordination, and
member advocacy skillsKnowledge about behavioral health community
resources, levels of care, criteria for levels of care and the
ability to appropriately develop and implement a care plan
following regulatory guidelines and level of care criteria
Familiarity with motivational interviewing and harm reduction to
engage and connect with membersKnowledge of severe and persistent
mental illness and substance use disorders Ability to work
collaboratively with BH vendorFamiliarity with software systems
including but not limited to Microsoft Office Products - Excel,
Outlook, and Word Fallon Health provides equal employment
opportunities to all employees and applicants for employment and
prohibits discrimination and harassment of any type without regard
to race, color, religion, age, sex, national origin, disability
status, genetics, protected veteran status, sexual orientation,
gender identity or expression, or any other characteristic
protected by federal, state or local laws. PM16PI176245073
Keywords: Fallon Community Health Plan, Fall River , Elderly Program Behavioral Health Case Manager - LICSW or LMHC, Executive , Fall River, Massachusetts
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