The Clinical Care Manager (CCM) provides intensive care coordination and clinical 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 CCM 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 CCM 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 Long Term Services and Supports and social determinants of health needs. This role drives outreach and engagement, 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.

The Adult Clinical Community Services (ACCS) LPHA Clinician promotes the full integration and functioning of adults with mental health conditions by way of providing comprehensive clinical community services. Working in a community based setting, the ACCS LPHA Clinician will perform clinical duties including intake, assessment, treatment planning and clinical interventions for assigned persons served, whether living independently in the community or in a Group Living Environment or Supported Independent Environment.

The ACCS LPHA Clinician will be responsible for determining person served needs for rehabilitative services as required by Medicaid Rehab Option for outreach and Group Home Living or Supported Independent Environments. This role will also provide leadership among the team by directing the delivery of Treatment Plan interventions by Team Outreach Workers, oversee treatment interventions of persons served in Group Home Living or Supported Independent Environments and model appropriate interventions. The ACCS LPHA will train and supports staff in delivering clinical evidence-based practices and best practices to all persons served, including Group Living Environment or Supported Independent Environments Program Directors and staff.

The Addiction Recovery Coordinator works as part of the interdisciplinary ACCS team and promotes the full integration and functioning of persons served needed to live successfully in their community. The Addiction Recovery Coordinator works collaboratively with person served to understand how the use of substances impacts their lives while also functioning as a resource to person served and other team members on substance addiction assessment, treatment, and rehabilitation techniques and resources.