About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The BH Care Coordinator serves as a bridge between the community and the health plan, health systems, BH vendor, government and social service systems and works in partnership with the Clinical Integration Behavioral Health Case Managers and Social Care Managers to facilitate member appointments, research providers, facilitate community resources, interact with members with the goal to enhance the Behavioral Health Case Manager’s and Social Care Manager’s ability to manage a larger member population. This role embeds in person at ACO partner locations

The role of the Behavioral Health Care Coordinator is to:

• maintain a general understanding of available behavioral health community resources and support groups, mental health services, social service and state agencies (e.g., DMH, DDS) and levels of care.
• screen members for behavioral health needs and/or social determinants of health using a specialized needs assessment.
• help connect members to the right resources, provide social support, informal counseling, assist with applications for state benefits, and advocate for an individual’s community health needs using a strengths perspective and motivational interviewing skills.

Responsibilities include:

• in person attendance at care planning meetings, care coordination meetings, partner communication meetings, and other face-to-face meetings with providers, partners, and members to perform assessments, train staff, coordination communication and otherwise represent Fallon Health in a positive way.
• conducting in home/office face to face visits for member identified as needing face to face visit interaction and assessments with the goal to coordinate and facilitate services to meet member needs according to benefit structures and available community resources.
• conduct assessments and refers members to Community Partner Programs such as Behavioral Health and Long-Term Services and Supports.
• may refer members to Flex Program as applicable depending upon the ACO the member is affiliated with.
• utilizes an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction.

Member Education, Advocacy, and Care Coordination

• Helps individuals, families, groups, and communities develop their capacity and access to resources, including health insurance, food, housing, quality care and health information.
• Assists with housing applications, state applications, SNAP and Fuel Assistance applications.
• Manages a subcase load in conjunction with the BH team.
• Collaborates with Community partners to assist members to access appropriate resources in regard to ED boarding and inpatient admissions when appropriate.
• Works with BH vendor to facilitate access to BH treatment. Supports members with appointment assistance when barriers to access arise.
• Provides informal coaching, support and follow-up as pertains to keeping and regularly attending scheduled appointments, groups, or outpatient programing.
• Conducts initial member depression, anxiety, and CAG screenings over the telephone and refers to team members per program protocol.
• Serves as an advocate for members to ensure they receive Fallon Health benefits as appropriate and if member needs are identified but not covered by Fallon Health, works with community agencies to facilitate access to programs such as community transportation, food programs, and other services available through senior centers and other external partners.
• Helps to support member healthier behaviors and lifestyle choices through motivational interviewing, psychoeducation, and informal coaching.
• Makes community visits to assist members with applications or other community resources.

Strictly observes HIPAA regulations and the Fallon Health policies regarding confidentiality of member information.

Care Team Communication

• Works collaboratively and ensures communication with members of the Care Team including but not limited to, medical providers and member/PRAs to ensure member care plan supports their needs.
• Performs TruCare queue management assigning new referrals to team staff and identifies and triages members for more urgent intervention by the team.
• Works collaboratively with BH Vendor to follow up on outstanding single case agreements, out of network agreements, or claims issues flagged by BHCMs, members directly, or other care team members.
• Provides regular updates on the status of appointment attainment, attendance, and member well-being to members of the care team.
• Communicates any changes in community providers, resources, and/or programs to the BHCMS.

Regulatory Requirements – Actions and Oversight

• Refers qualifying members to Behavioral Health Case Management based on program protocol.
• Maintains and updates TruCare, External EMR, and associated reports per Program processes for members.
• Performs other responsibilities as assigned by the Manager/designee.
• Supports department colleagues, covering and assuming changes in assignment as assigned by Manager/Designee
• May mentor and train staff on processes associated with job function and role.

Education:

College degree (BA/BS in Psychology, Health Services field or BSW Social Work) preferred or 5 years’ experience in a behavioral health related field and/or community social service agency

License/Certifications:

License:   Reliable transportation   

Certification:  None   

Other:  Satisfactory Criminal Offender Record Information (CORI) results.

This role requires compliance with the ACO Partner Health and Educational requirements.

Experience:

• 3+ years job experience in a behavioral health related field and/or community social service agency required
• Experience with telephonic interviewing skills and working with a diverse population required
• Experience utlizing telephonic and in-person interpretation required
• Experience with informal counseling, coaching, and motivational interviewing required
• Experience in a healthcare managed care company, nursing facility, or in a Massachusetts Aging Access Service Point Agency or State Social Service Agency including DMH, DDS, and DCF preferred
• Fluency in Spanish, Vietnamese or Portuguese preferred
• A mandatory requirement for this position is a basic understanding of Serious Persistent Mental Illness (SPMI), addictive disorders, as well as the Disability Culture, Developmental Disabilities, the homeless population, adolescent, Children with Behavioral Health Intervention (CBHI) services, and Managed Care Organizations.

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.

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