Bay State Community Services (BSCS) values all types of human diversity. Everyone contributes to the improvement of BSCS and the greater community. We remain committed to raising awareness and joining efforts of justice, equity, and inclusion.

Job Summary

The Care Coordinator for the Behavioral Health Community Partners (BH CP) program works in collaboration and continuous partnership with chronically ill or “high risk” enrollees and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach.

What You Will Be Doing to Make a Difference...

• Work collaboratively and effectively with care management team, including Assigned or Engaged Enrollees, their family/caregiver(s), medical team, and other providers to coordinate BH care management services.
• Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitate changes as needed.
• Create ongoing processes for patient and family/caregiver(s) to determine and request the level of care coordination to support their desire at any given point in time.
• Ensure the plan meets the requirements of EOHHS and notify the ACO/MCO if changes have occurred, since the completion of the Comprehensive Assessment.
• Facilitate patient access to appropriate medical and specialty providers.
• Educate patient and family/caregiver(s) about relevant community resources.
• Facilitate and attend meetings between patient, family/caregiver(s), care team, payers, and community resources as needed.
• Ensure that the Engaged Enrollee receives the necessary assistance and accommodations to prepare for, fully participate in and to the extent preferred, direct the treatment planning process. Ensure the Engaged Enrollee receives assistance in understanding BH terms and BH concepts, including but not limited to information on their functional status; how family members, social supports and other individuals of their choosing can be involved in the treatment planning process; self-directed care options and assistance available to self-direct care; and BH services or programs that are available to meet their needs and for which they are potentially eligible.
• Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals.
• Assist with the identification of “high-risk” enrollees (the chronically ill and those with special health care needs), and flag in the EMR.
• Conduct assessment for Flexible Services for all Engaged Enrollees who are enrolled in an ACO. If Flexible Services are identified, make recommendation to ACO for approval.
• Provide health and wellness coaching as directed by the Engaged Enrollee’s care team and as indicated in the Enrollee’s care plan.
• Maintain regular contact with Engaged Enrollee to monitor and coordinate care planning including quarterly face-to-face meetings.

Requirements

• 1 year of experience working with mental health/substance use disorders with a Bachelor’s degree in a social services field; or
• 2 years of experience working with mental health/substance use disorders with Associates Degree or No Degree
• Strong Computer Skills
• Experience with EMR systems and reports is desirable
• Highly organized with the ability to keep accurate notes and records
• Driving Requirements: Valid MA Drivers’ License; Must be 21; Regular access to reliable transportation required; Driving report from Registry of Motor Vehicles upon hire
• Local knowledge about and connections to community health care and social welfare resources is desirable
• Bilingual Speakers (Haitian Creole, Spanish, Portuguese, Cape Verdean Kriolu, etc.) encouraged to apply

Bay State Community Services (BSCS) recognized the hard work and dedication of our staff and has developed a comprehensive benefit package to support you and your family.

Benefits Begin On Your First Day of Employment

Important Health and Wellness Benefits

Blue Cross and Blue Shield Health and Dental Insurance

Eye-Med Vision Benefits

Employer Paid Life and Long-Term Disability Insurance

Medical Flexible Spending Account and Dependent Care Account

Employee Assistance Program

Generous Paid Time Off

35 Days Paid Time Off (15 Vacation Days, 12 Holidays including Juneteenth and 8 Sick Days)

Additional Benefits

Retirement Plan 403(b) (employer match after the first year of employment)

Opportunities for Reduced Tuition for Clinical Master's Degree

Opportunities for Student Loan Forgiveness

Tuition Assistance

Mileage reimbursement

Extensive Training Program

Monthly Agency Wide Trainings (includes CEU's for obtaining/retaining license - LMHC, LMFT, LADC, CARC, LCSW and LICSW)

Supervision for Licensure and Specializations

Immediate Access to Comprehensive Online Self-Paced CEU Trainings

Opportunities for Certification in Evidence Based Practices

Bay State Community Services is an equal opportunity employer. We are committed to providing an environment free from bias, discrimination, or harassment of any kind, and mutual respect where equal employment opportunities are available to all qualified applicants and teammates without regard to race, ethnicity, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law.