Substance Abuse​/Sud Care Manager - LCSW, LICSW, LMHC or LADC - Hybrid

Substance Abuse / SUD Care Manager - LCSW, LICSW, LMHC or LADC preferred - Hybrid

Join Fallon Health as a Substance Abuse / SUD Care Manager, a critical role that bridges members with substance use disorder needs and our network of providers. This hybrid position supports integrated, member-centered care through coordination, education, quality monitoring, and advocacy.

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.

The SUD Care Manager ensures seamless coordination of care for Fallon Health members with substance use disorder (SUD) needs. They collaborate with Carelon Behavioral Health, psychiatric units, SUD treatment facilities, Community Behavioral Health Centers (CBHCs), and other partners to promote integrated, member-centered care. The role drives discharge planning, facilitates communication across care teams, and connects members to appropriate care management services and community resources.

• Clinical Coordination & Member Care – Conduct daily review of SUD Census reports, disseminate member-level information to Fallon Care teams, collaborate with clinical teams on treatment and discharge planning, and address high-risk members.
• Provider & Partner Engagement – Provide consultation and education about SUD clinical programs, act as liaison with SUD facilities and community providers, and ensure contracted providers understand plan benefits and care coordination needs.
• Quality & Performance Monitoring – Monitor SUD HEDIS measures, liaise with the BH/SUD quality team, and recommend program improvements.
• Workflow & Compliance – Develop workflows, educate team members, observe HIPAA regulations, and coordinate healthcare services in compliance with care plans.
• Member Advocacy & Resource Navigation – Serve as subject matter expert on entitlements, maintain awareness of community resources, and advocate for members to obtain benefits and community services.

• Master’s degree from an accredited school of social work, mental health counseling, psychology, or human services.
• Active, unrestricted license as a LCSW, LICSW, or LMHC; LADC preferred.
• Certification in Case Management a plus.
• Satisfactory Criminal Offender Record Information (CORI) results.
• Minimum of 3 years of experience in behavioral health or case management.
• Knowledge of SUD programs, 42
  
  CFR part 2, and HEDIS measures.
• Strong communication and collaboration skills.
• Familiarity with HIPAA regulations and confidentiality standards.
• Reliable transportation.

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.

Mid-Senior level – Full-time – Health Care Provider – Insurance