Community Health Worker- Taunton
Bay Cove Human Services, Inc.

Job Info

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Bay Cove Human Services' mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the challenges associated with developmental disabilities, mental illness, substance use disorders, and homelessness at more than 175 program sites throughout Greater Boston and Southeastern Massachusetts.

Bay Cove Human Services is committed to ensuring the representation and participation of candidates from diverse backgrounds and experiences. We encourage all qualified individuals, particularly those from historically marginalized groups, to apply.

Schedule: Mon-Fri 8am-4pm or 9am-5pm No weekends, no evenings, no on call

Job Summary:

The Community Health Worker (CHW) provides care coordination and care management for MassHealth Members with complex medical and behavioral health needs who are enrolled in an Accountable Care Organization (ACO) or Managed Care Organization (MCO) plan. The CHW collaborates with the Community Partner team and the clinical staff of each Enrollee's ACO/MCO's plan to minimize duplicative efforts, promote integrated care, ensure quality and continuity of care, and support the values of person-centered planning, Community First and SAMHSA Recovery Principles. The CHW is at the helm of organizing and coordinating resources and services in response to the Enrollee's healthcare needs across multiple settings, and inclusive of both LTSS and SDH needs. This role drives assessment and care planning, care transitions, health and wellness coaching, as well as community and social services connections in partnership with Enrollees and their care teams.

This is a non-exempt position.

Essential Functions of the Position:

• Conduct initial and ongoing risk assessment; design personal crisis management plans, relapse prevention and harm reduction strategies with members who have been identified as behaviorally complex in collaboration with team LPHAs.
• Coordinate the development, implementation, and ongoing review of the Person-Centered Treatment Plan (PCTP) inclusive of any LTSS and / or SDH needs or goals of the Enrollee.
• Drive referrals regarding connections to any community or social services that align with the Enrollees needs and goals including obtaining required Prior Authorization from ACO/MCO Plan for relevant/necessary services.
• Collaborate closely with PCP and other providers, including but not limited to community resources, to assure appropriate referrals based on level of care needed to optimize outcomes and minimize risk.
• Manage all care transitions through collaboration with Enrollee, community provider staff, ICT and hospital staff to ensure a safe discharge plan and a well-coordinated implementation of that plan.

Job Requirements:

• Minimum of 3 years care management experience working with people living with SMI and/or SUD preferred.
• High school diploma or equivalent is required. BA/BS in human-services related fields preferred. Certified Community Health Worker (CHW) preferred.
• Preference given to bi-lingual/bi-cultural applicants and those with lived experience of psychiatric conditions. In some cases, experience may be substituted for academic training.
• Driving is a requirement for this position using a personal vehicle. You must possess and maintain adequate insurance as well as maintain a safe driving record which is subject to annual checks. A valid driver's license must be presented at the time of employment.

This job has expired.