Substance Abuse / SUD Care Manager - LCSW, LICSW, LMHC or LADC preferred - Hybrid

Fallon Health•Worcester, MA

9d•$90,000 - $100,000•Hybrid

About The Position

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 SUD Care Manager is responsible for ensuring seamless coordination of care for Fallon Health members with substance use disorder (SUD) needs. This role serves as a critical liaison between Fallon Health, Carelon Behavioral Health, and a network of providers—including psychiatric units, SUD treatment facilities, Community Behavioral Health Centers (CBHCs), and other partners—to promote integrated, member-centered care. The SUS Care Manager drives effective discharge planning, facilitates timely communication across care teams, and ensures members are connected to appropriate care management services and community resources. Additionally, the role supports provider and member education, participates in interdisciplinary care planning, and fosters collaborative relationships to improve care quality, reduce gaps in service, and enhance member outcomes.

Requirements

Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services required
Active, unrestricted license as a LCSW, LICSW or LMHC
Satisfactory Criminal Offender Record Information (CORI) results.
Minimum of 3 years of experience in behavioral health or case management.
Knowledge of SUD programs, 42CFR part 2, and HEDIS measures.
Strong communication and collaboration skills.
Familiarity with HIPAA regulations and confidentiality standards.

Nice To Haves

LADC preferred.
Certification in Case Management a plus

Responsibilities

Clinical Coordination & Member Care Conduct a daily review of SUD Census reports and disseminate member-level information to assigned Fallon Care teams
Collaborate with clinical teams of assigned SUD providers on treatment plans and discharge planning of members on inpatient units and boarding in emergency departments to assist in transition to community
Works collaboratively and cohesively with all members of the care team (both internal and external staff and providers)
Collaborates with the interdisciplinary team in identifying and addressing high risk members
Provides culturally appropriate care coordination, i.e., works with interpreters, provides communication approved documents in the appropriate language, and demonstrates culturally appropriate behavior when working with members, family, caregivers, and/or authorized representatives
Provider & Partner Engagement Provide consultation and education regarding SUD clinical programs to ACO Partners, Fallon Care Management teams and primary care settings
Act as primary liaison with SUD facilities at all levels of care and community providers to assist with treatment planning as needed
Works with Fallon Health Provider Relations and Carelon to ensure that contracted SUD providers are knowledgeable about the plan benefits, eligibility requirements, and care coordination and communication needs
Quality & Performance Monitoring Monitor SUD HEDIS measures and identify opportunities for improvement
Act as a liaison with BH/SUD quality team
Offers recommendations to continued program development and is an active participant in suggesting opportunities to enhance the program
Workflow & Compliance Develops workflows and educates Team on workflows as appropriate
Strictly observes HIPAA regulations and the Fallon Health policies regarding confidentiality of member information
Follows department and regulatory standards to authorize and coordinate healthcare services ensuring timeliness in compliance with documented care plan goals and objectives
Performs other responsibilities as assigned by the Clinical Manager/designee
Member Advocacy & Resource Navigation Act as a subject matter expert in federal/state/community entitlement and other benefit programs keeping up to date with current guidelines and program availability, access details and other pertinent details associated with eligibility and obtainment
Maintains an ongoing awareness of clinical, social, and financial resources available in the community
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