AFC Case Manager

Facilitate and coordinate AFC home placement and support services based on each individual’s needs, goals, and preferences.

Coordinate the referral, intake, assessment, and placement processes.

Assist in the development and ongoing review of Individual Care Plans (ICPs) and Individual Support Plans (ISPs).

Work collaboratively with families, caregivers, medical professionals, and community service providers to ensure coordinated and comprehensive supports.

Promote individual choice, self-expression, and personal accomplishment through person-centered practices.

Participate in planning to ensure health, safety, and overall well-being of AFC participants.

Complete and maintain all documentation as required by KDC, MassHealth, and other applicable funding agencies.

Input, track, and update information in the Electronic Health Record (iCentrix), including data entry, uploading documents, finalizing, and closing records.

Maintain compliance with regulatory timelines, documentation standards, and internal quality expectations.

Serve as a liaison with funding agencies in collaboration with program leadership.

Participate actively in staff meetings, individual and group supervision, and case reviews.

Communicate effectively with team members, individuals, caregivers, and external partners to ensure collaboration and service consistency.

Participate in professional development activities and trainings to maintain required skills and stay informed of AFC and MassHealth regulations.

Assist in outreach and program-related community engagement or fundraising activities as assigned.

Perform other job-related responsibilities as assigned by program leadership.

Bachelor’s degree in Social Work, Psychology, Human Services, Nursing, Public Administration, or a related field.

Minimum of 1 year of experience in human services, long-term supports, disability services, or a related program area.

Understanding of home- and community-based service models, AFC, Shared Living, or related MassHealth programs.

Excellent communication, organizational, and interpersonal skills.

Proficiency with Electronic Health Records (EHR), and Microsoft Office Suite.

Valid driver’s license and reliable transportation for travel.

Ability to complete all required trainings required such as CPR and First Aide.

Experience working in community-based programs.

Experience with Medicaid, MassHealth, and state funding systems.

Experience providing coaching, mentoring, or guidance to staff.

Bilingual or multilingual skills.

Travel: Frequent travel to AFC member homes, caregiver residences, community settings, and program offices across the service region. Travel may require navigating urban, suburban, and rural areas, with occasional exposure to inclement weather.

Mobility & Activity: Regular walking, standing, climbing stairs, and moving through a variety of home and community environments during visits and assessments. Must be able to respond quickly during emergencies or when providing in-field support to case managers or caregivers. Must be able to lift, carry, or move a minimum of 25 lbs as needed during home visits, emergency response, or when assisting staff or caregivers in the field.

Computer & Documentation: Ability to sit for extended periods while completing electronic documentation, data entry, and reporting within the Electronic Health Record (iCentrix) and other required software platforms.

Telephone & Communication: Frequent phone, email, and virtual communication with case managers, caregivers, members, families, and external providers. Requires clear, professional, and timely communication skills.

Schedule Flexibility: Ability to work varied hours to meet program and member needs, including occasional evenings or weekends.

Field Support & Assistance: Occasional hands-on support for staff or caregivers during home visits, including guidance in safe practices, crisis response, or behavior support interventions as appropriate within the AFC model.

Safety & Situational Awareness: Maintain consistent awareness of home and community environments to ensure safety for members, caregivers, staff, and self. Provide oversight and coaching in trauma-informed approaches and crisis-prevention strategies.

Emotional Demands: Regular exposure to sensitive or complex family dynamics, caregiver stress, and member health or behavioral challenges. Requires resilience, empathy, sound judgment, and the ability to remain calm and solution-focused.