ESWA Long Term Services and Supports - Care Coordinator

ESWA Long Term Services and Supports - Care Coordinator

Join to apply for the ESWA Long Term Services and Supports - Care Coordinator role at Open Sky Community Services

At Open Sky Community Services, we open our doors, hearts, and minds to the belief that every individual, regardless of perceived limitations, deserves the chance to live a productive and fulfilling life. We are on an anti‑racist journey, committed to learning, living, and breathing inclusion, opportunity, diversity, racial equity, and justice for ALL. With over 1,300 compassionate, highly‑trained professionals, we implement evidence‑based practices that positively impact communities across Central Massachusetts and beyond.

As a trauma‑informed organization, we value transparency, sensitivity, self‑care, and a culture of continuous learning.

• Excellent supervision (individual and group), professional development, and training opportunities
• Generous paid time‑off plan – 29 days in first year (12 paid holidays), increasing to 32 days in the second year and up to 43 days (over 8 weeks) thereafter
• Tuition reimbursement program and reimbursement for human‑services certifications
• Medical, dental and vision insurance with prescription plan
• 403b retirement plan with employer match
• Life insurance – 100% employer‑paid
• Eligible employer for the Public Student Loan Forgiveness Program
• And more…

Open Sky celebrates diversity and is proud to be an Equal Opportunity Employer. Qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, veteran status.

The Central Community Health Partnership is a collaboration of five premier human service organizations in Central Massachusetts, selected to provide Behavioral Health and Long‑Term Services and Supports through the Mass Health program. We help Mass Health members with complex needs navigate the network of community‑based services and information, ensuring that every member receives the right care at the right time.

In collaboration with the Care Manager and Registered Nurse, you will serve as the primary point of contact, providing outreach, engagement, assessment, and person‑centered treatment planning for individuals enrolled in the CCHP's Long Term Support Services Community Partners Program. You will engage members eligible for the program within prescribed timelines, help them navigate community‑based services, conduct in‑person assessments, and maintain regular contact according to contractual requirements and individual needs.

• Participate in the development and implementation of program goals, objectives, and work‑plan tasks aligned with the mission and vision of CCHP.
• Use a person‑centered framework to identify enrollee and/or caregiver goals, preferences, desired level of involvement, and address cultural considerations or interpreter services.
• Coordinate access to services and fulfillment of integrated health needs with providers—specialists, primary care physicians, social service agencies, and others—as directed by the care plan.
• Interface with referral agencies, specialists, behavioral health, medical providers, and other stakeholders to gather information (including existing medical, behavioral health, and treatment plans) to create a comprehensive Integrated Treatment Plan (ITP).

• High School Diploma, GED, or equivalent.
• Valid driver’s license, reliable transportation, and acceptable driving record.
• Previous experience in community‑based behavioral health support programs (e.g., community health worker, peer specialist, or recovery coach).
• Prior experience with adults with mental illness or substance use disorders, and navigating local resources and treatment systems.

Entry Level

Full‑time

Other

Mental Health Care