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Fallon Health Behavioral Health Care Coordinator-ACO Team - Remote - Pediatric Exp Preferred in Worcester, Massachusetts


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.

Brief summary of purpose:

The role of the Behavioral Health Care Coordinator (BH CC) 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. The responsibility of the BH CC is to screen members for behavioral health needs and/or social determinants of health using a specialized needs assessment. The BH CC helps 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. The BH CC possess a basic understanding of Serious Persistent Mental Illness (SPMI), addictive disorders, as well as the Disability Culture, Developmental Disabilities, the homeless population, geriatric, Children with Behavioral Health Intervention (CBHI) services, and Managed Care Organizations.The BH CC 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, Social Workers, and Social Care Managers to facilitate member appointments, research providers, facilitate community resources, interact with members with the goal to enhance the Team’s ability to manage a larger member population. The BH CC works in conjunction with the Supervisor/Manager to assign members to the BH Team according to assignment logic and caseloads.


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

  • Collaborates with Community partners to assist members to access appropriate resources in regards to ED boarding and inpatient admissions when appropriate.-

  • Assists with housing applications, state applications, SNAP and Fuel Assistance applications

  • Manages a subcase load in conjunction with the BH team

  • 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 CAGscreenings 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 home visits to those who are homebound and/or require in-person assistance 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 and associated reports per Program processes for members

  • Performs other responsibilities as assigned by the Supervisor/Manager/designee

  • Supports department colleagues, covering and assuming changes in assignment as assigned by Supervisor/Manager/Designee

  • May mentor and train staff on processes associated with job function and role



College degree (BA/BS in Psychology, Health Services field or Social Work) preferred


  • 2+ years job experience in a managed care company, medical or behavorial health related field, or community social service agency required

  • Understanding of hospitalization experiences and the impacts and needs after facility discharge required

  • Knowledgeable about medical terminology and basic understanding of common disease processes and conditions required

  • Knowledgeable about medical record documentation and able to recognize triggers requiring RN intervention required

  • Experience with telephonic interviewing skills and working with a diverse population, that may also be Non-English speaking required

  • Understanding of the impacts of social determinants of health required

  • Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word required

  • Experience working in a community social service agency, skilled home health care agency, community agency such as adult foster care, group adult foster care, personal care management agency, independent living agency, State Agency such as the Department of Mental Health (DMH), Department of Developmental Services (DDS), Department of Children and Families (DCF), and/or the Department of Youth Services (DYS), or other agency servicing those in need required

  • Experience conducting face to face member visits and interacting with providers and community partners preferred

  • Experience in a nursing facility or in a Massachusetts Aging Access Service Point Agency preferred

  • Experience working on a multi-disciplinary care team in a managed care organization preferred

AND IF Working with the ACO Member Population:

  • 2+ years of experience working with people up to age 65 with a focus on working with people that are on MassHealth coverage and may be encountering social, economic, and/or multi complex medical and or behavioral health conditions required

  • Effective telephonic interviewing skills and the demonstrated ability to coordinate MassHealth benefits such as transportation through the State PT-1 process preferred

  • IF focused to work with the pregnant member population, 2+ years of experience working with pregnant females during the prenatal, delivery, and postpartum time working in conjunction with RNs coordinating care required

Performance Requirements including but not limited to:

  • Excellent communication, customer service and interpersonal skills with members and providers via telephone

  • Exceptional customer service skills and willingness to assist ensuring timely resolution

  • Appreciation and adherence to policy and process requirements

  • Independent learning skills and success with various learning methodologies including but not limited to: self-study, mentoring, and group education

  • Working with an interdisciplinary care team as a partner demonstrating respect and value for all roles and is a positive contributor within job role scope and duties

  • Willingness to learn about community resources available to assist the member population in the community and demonstrated willingness to seek resources and expand knowledge to assist the population

  • Willingness to learn insurance regulatory and accreditation requirements

  • Knowledgeable about medical and behavioral health terminology and basic understanding of common disorders and conditions

  • Knowledgeable about medical record documentation and able to recognize triggers requiring escalation to a Behavioral Health Case Manager and/or crisis team

  • Knowledgeable about software systems including but not limited to Microsoft Office Products – Excel, Outlook, and Word


  • Demonstrates commitment to the Fallon Health Mission, Values, and Vision

  • Specific competencies essential to this position:

  • Problem Solving

  • Asks good questions

  • Critical thinking skills, looks beyond the obvious

  • Adaptability

  • Handles day to day work challenges confidently

  • Willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change

  • Demonstrates flexibility

  • Written Communication

  • Is able to write clearly and succinctly in a variety of communication settings and style

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-Worcester

Posted Date 1 month ago (10/26/2021 5:36 PM)

Job ID 6585

# Positions 1

Category Behavioral Health