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Overview

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.

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

Qualifications

Education:

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

**License** :

Active, unrestricted license as a LCSW, LICSW or LMHC; LADC preferred. reliable transportation

**Certification** :

Certification in Case Management a plus

Other:

Satisfactory Criminal Offender Record Information (CORI) results.

Experience:

+ 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.

:

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $90,000 - $100,000 per year, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

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.

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**Location** _US-MA-Worcester_

**Posted Date** _1 day ago_ _(12/29/2025 2:35 PM)_

**_Job ID_** _8192_

**_\# Positions_** _1_

**_Category_** _Behavioral Health_