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Fallon Health Behavioral Health Case Manager - LICSW or LMHC - Flexible Remote! in Fall River, Massachusetts


This 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.

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.


Assessment 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 Care

  • Coordinates 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 Team

  • Works 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 presentations



Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required.


  • License: Active, unrestricted license as an LICSW and/or LMHC or license-eligible, reliable transportation to be used for home visits

  • Certification : Certification in Case Management preferred

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


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 :

  1. 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 health

  2. Ability 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 navigators

  3. Ability to assist members with relevant food, housing and state applications (e.g. DDS, DMH)

  4. Experience with subpopulations including children, adolescents, the homeless, and those with disabilities,

  5. Effective case management, care coordination, and member advocacy skills

  6. Knowledge 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

  7. Familiarity with motivational interviewing and harm reduction to engage and connect with members

  8. Knowledge of severe and persistent mental illness and substance use disorders

  9. Ability to work collaboratively with BH vendor

  10. Familiarity with software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word

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.

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.


Location US-MA-Fall River

Posted Date 5 months ago (4/25/2022 4:53 PM)

Job ID 6826

# Positions 1

Category Behavioral Health