Outreach Care Coordinator ($2,000 sign on bonus)
Company: Fall River Group, Inc
Location: Fall River
Posted on: January 13, 2022
Family Service Association is a comprehensive private,
non-profit social service agency dedicated to the development and
implementation of services designed to provide strength and support
to individuals and families throughout southeastern Massachusetts.
Headquartered in Fall River, Family Service Association strives to
increase the capacity of individuals and families to cope with the
stresses of family life and interpersonal relationships in a
positive, productive and health-improving manner. This agency is a
leading provider of professional social services in the South Coast
region of Massachusetts, with a 130-year tradition of high
$2, 000 SIGN ON BONUS AVAILABLE***
We have a full time (40 hours per week) The hours are Monday
through Friday, 8:00 a.m. - 5:00 p.m.
Outreach Care Coordinator position in our Long Term Services and
Supports (LTSS) Community Partners (CP) program in the Fall River
area and surrounding region.
The Long Term Services and Supports (LTSS) Community Partners (CP)
Outreach / Care Coordinator is responsible for making initial
contact with hard to reach members and promoting coordination in
the delivery and receipt of services to enrollees assigned by
Accountable Care Organizations (ACO) and Managed Care Organizations
(MCO), or Mass Health.
Duties and Responsibilities:
Respect the confidential nature of all program services and
Conduct outreach to assigned enrollees to inform about the
functions of a CP Program, role of the Care Coordinator, the
optional nature of CP enrollment, choice in CP providers, the
benefits of enrollment and the process for enrolling. Provide
written documentation to members as warranted.
Document all outreach attempts which typically include a minimum of
3 phone call attempts; and additional strategies including
face-to-face attempts if warranted, and other correspondence.
Make contact with members during outreach to complete Follow Up
after Discharge summary as needed.
Schedule Intake appointments for Care Coordinators as
Complete Risk Assessment as required.
Inform potential member of Participation Agreement and facilitate
sending it to the enrollee.
Facilitate warm hand-off for completion of Comprehensive Assessment
with ACO / MCO partners.
Responsible for marketing program to ACO / MCO Health Centers,
hospitals, PCP offices and other entities including maintaining
collaborative relationships with same.
Responsible to delegate assignments to part-time Outreach Worker as
Determination of caseload assignments per geographic area on a
Complete No Contact, Disengagement, request for information, Intake
Packet and other letters as required to send to members during
absence of Intake Specialist.
Completion of disenrollment forms for members on assigned
Assignment as Care Coordinator to assist in gaps in coverage as
needed, or in growing area of need in a geographical region,
including but not limited to the following duties and
Obtain the Comprehensive Assessment from the referring ACO/MCO,
integrate findings into person-centered Care Plan and provide
update as needed for any changes in functional status, ADL, or IADL
Ensure LTSS Care Plan is approved by the Enrollee and the Primary
Care Provider within required time frames. Ensure Care Plan is
shared with all members of the care team.
Facilitate enrollee's access to needed services, including but not
limited to, Flexible Services, ACO/MCO chronic disease management
programs, LTSS and other Community Resources.
Maintain regular contact with the enrollee to monitor and promote
progress toward Care Plan goals; to assist the enrollee to navigate
and access needed services: to provide ongoing monitoring of the
implementation of the LTSS Care Plan; to monitor for changes in
status including health, housing, natural supports and caregivers
and to provide health and wellness coaching with a minimum of one
face-to-face contact quarterly.
Maintain all documentation required for the delivery of LTSS
Community Partners services.
$2, 000 SIGN ON BONUS AVAILABLE***
Education and Experience:
Must have a minimum of a Bachelor's Degree in social work, human
services, nursing, psychology, sociology, or a related field; or,
an Associate's Degree and at least one year of experience in the
field. Must have strong written and oral communication skills and
demonstrated computer skills. Prior experience in marketing or
customer services preferred.
Family Service Association is an Equal Opportunity Employer.
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Keywords: Fall River Group, Inc, Fall River , Outreach Care Coordinator ($2,000 sign on bonus), Other , Fall River, Massachusetts
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