substance abuse counselor

licensed practical nurse

client services coordinator

nurse

clinic manager

Community Medical Services

It sounds great with what they fill your head with in the beginning and let me tell you that will change. You will be constantly stressed out trying to do your job. Then you have management come in and tell you that you can't do that. Or your not dping your job at all. They always come in and step in yout place and do your job right in front of you.  While your off to the side trying to figure out why they did that. Which only causes issues. There is no support what so ever. When you ask for it or you have concerns you are their new target and they want you out. You only get support from the few of your staff on your actual shift. But becareful. Your not allowed to talk about anything with out it being seen as you are bringing down the clinic mural or talking bad. When in reality you never did. You come forward about something and you become the new target. They will put you in so many uncomfortable situations and expect you to not have mental health reactions. And when you do have panic attacks in front of them they tell you that your being insabordanate. 
Yet they want you to have experiences that the clients have had because you can understand them better. Haha that's a joke. They cant treat their staff right. They never give staff chances. Just the one that they favor. When your trying to keep a policy or rule going they will allow the clients to not have to follow it causing the sutuation to be more stressful and so when you enforce it you seem like the problem. Causing your clients to retaliate against you.

Management and supervisors will remind you how our unhoused can be since they tend to go through behaviors. That they like you one day and then might not the next day. Yet don't allow thst to be a thing when a client is upset with the staff who enforces policy and rules. Since that is their actual job. 

When you do have issues and you try and talk about them with your supervisor or management they just try to figure out ways to get you gone faster. 

In fact instead of coaching or talking with you. Potential 1st or 2nd written write ups. Nope they go straight for the final written warning. When you question other talks about the situation because they didn't happen, they tell you that they did. 
HR doesn't do anything. You reach out to them like they ask and then they ignore you the whole time with your questions and concerns. 

SOOOO MUCH FAVORITISM FOR THE OTHER SHIFT 

Even when it's brought up in a meeting to get through, the management and supervisors will tell you they don't see it and make you feel like your making things up. They will continually ask for examples even though you have given many different one. Even though they know it's there. They just don't want to admit it. 

ONE TEAM, ONE CALLING. WHAT A JOKE

They take patients in who are not even on opioids or fetnyal or even addicted because they just want bodies for their census. 
When a client tells them they want to go to another clinic they won't discharge the patient for 30 + days. When in order to go to a clinic you need to be fully discharged. They just want their census up even though that's messed up for the patient wanting to get the help. 

Communication sucks tremendously in this clinic. Communication with the provider, the manager, the clinic supervisor. When they are working from home you can expect no answers. And if they do its 30 + minutes after the patient needed them. They have better things to do at home than work even though they are supposed to be working. Work from home. Usually means your home working. Not doing other things in life. The provider would be working but not. They would be working out getting paid posting about it in teams chat and not answering the clinic when they would call for things they needed. 

Not even full fulltime job. 36 hours a week. When you reach out and ask about making up the 4 hours each week, management ignores you and gives everyone else 4 hours to make up each week to get their full 40 hours a week. While your still only getting 36 and your the one who wanted the extra 4 hours so you can make all ends meet. 
They really don't care about you. They don't investigate anything. They just say you did it even if you didn't and that is that. They don't care about anything or even you. You have to be someone special to them to get them to care about you. 

Working at CMS is fun and the organization successfully strives to be collaborative, inclusive, and not hierarchical.  I've been with the company for 6-7 years. I started as a counselor, became Lead Counselor, and am now in management. I can honestly say I love the company and believe I get the chance to do good on a daily basis and am mostly supported in doing so.

Every Friday the CEO and COO host an inspiring Town Hall via video conference call where all employees can post anonymous questions, comments, concerns, shout outs, ideas, and they are voted up or down by the other staff and addressed by the execs followed by open discussion.   The CEO and COO, and several of the senior leaders, truly care about what employees think and genuinely want to have a healthy company for clients and employees. They are funny and personable.  Further, these leaders have secure egos and can handle the feedback.  It's refreshing to work for mature people like this! Let's face it—it is rare!

CMS is legitimately dedicated to both good compliance practices as well as the principles of harm reduction for substance use disorders. The company strives to meet our clients working through their Opioid Use Disorder where they are at and is passionate about achieving good outcomes for these clients.  Part of this Town Hall is dedicated to client success stories and each week it is touching and inspiring.  Let's face it, those of us who have lasted in this field (11 years for me) are really here because of the clients :)

There are many cool initiatives that have been long in the making but are starting to bear fruit related to: clinical programming, contingency management, outcome tracking, holistic health. The clinical programming enhancement has been an uphill battle and has been, a bit too much, of a grassroots or bottom-up push. 

This is the type of company where if you are positive and bring creative enthusiasm to work, and are open to learn and grow, you will go far. If you have some basic skill in your position, and are aligned with the company's Mission, Vision, and Values (clearly stated on website and actually lived by),  then it seems to me you will have job security. 

Job advancement is another matter. While I have been promoted twice in six years, that is not the norm.  The company has been working on employment tracks for a long time and doesn't seem to have made much headway.  However, we have a burgeoning HR department and I am hopeful.

The biggest areas that I see CMS needing to improve on would be deepening our clinical vision and employee development.

CMS tends to focus on operational systems to address issues, including clinical care. This is exciting and yields some efficiencies that improve the lives of staff and clients. However, sometimes CMS forgets to have a really in-depth clinical look at things. Clinical vision could use some enhancement.  We could come up with genius ways to see more clients, but forget to really look hard enough at what we will do with them clinically when we meet with them. This would inspire counselors and peer supports, engender trust in the senior leadership, and result in a higher level of care for clients.


Nonetheless, if you are someone that wants to make a difference for the population working through Opioid Use Disorder, this is a great company to work for.

The clinic opens at 5:30AM and is usually quite busy with clients for the first half hour. Counselors are required to participate in a daily Teams meeting at 7AM to discuss how many counseling sessions and behavioral health engagements they completed the day before. Individual sessions are conducted around 3-hour shifts of working the front desk due to staff shortages. Walk-in intakes are expected to be prioritized around scheduled counseling sessions. There is little to no time in between sessions to complete clinical documentation and many counselors struggle to complete same-day documentation. 
While at CMS, I increased my familiarity in maintaining open and honest communication with my clients regarding my availability and ability to respond to time-sensitive requests. 
Management has a high turnover rate. During my time at CMS (1 year and 10 months), I observed the firing of 3 Clinic Managers and 1 Regional Director. Management consists of individuals with business degrees and no knowledge of clinical mental health. Management tends to view employees as lazy and easily replaceable. Management is not receptive to feedback, questions, or concerns from employees. 
Counselors struggle to maintain caseloads of over 100 clients each while being demanded to achieve 80% on-time counseling at all times, no exceptions. Counselors are required to work the front desk when a front desk worker is not available, resulting in counselors having to frequently cancel/reschedule counseling sessions. Counselors do not receive adequate training/guidance/support from management and are treated with hostility when in need of assistance. 
Building therapeutic relationships with clients and being a part of their recovery journey is the most enjoyable part of the job, however, time constraints on the length and frequency of counseling sessions present a barrier to the therapeutic relationship, which is unfortunate. 

While the Revenue Cycle Department offers a hybrid work environment, the daily micromanagement of daily, early morning   meetings  that last most times 30 minutes to over an hour  to  report the work you are doing each day   and what you finished is counter productive. It is nearly impossible to complete your weekly work with the DAILY meetings to talk about what you got done  THE DAY BEFORE in addition to a weekly one  on one  AND a weekly team meeting !  Usually staff will  be called out  in front of your peers if you are unable to finish your weekly spreadsheet  by the end of the week. Humiliation  is  used to motivate a person to get work done.  This did not happen to me specifically but I witnessed it  almost daily! The eye rolling and deep sighs, the interrupting and over talking of each other is unprofessional and creates a negative environment.   The pay is average  but not worth the toxicity and micromanagement  from the 2 Billing Managers.  In addition, many of the management staff have or had previously worked with the VP and the culture was clique-ish and hostile. The managment team insisted the billing staff work in the office one or 2 days a week and you would almost always be in this huge office BY YOURSELF  or with  1 other team member- The management team also only came in one or 2 days a week.  The team hardly interacted with  each other  unless on teams chat  but the managers controlled those meetings. The training to do your actual job and learn how to use the Database and system was minimal. You were expected to follow along to the most convoluted and lengthy SOP's. The company needs to switch to a fully integrated EMR-  the billing team was expected to manually create patient statements using Excel sheets and complicated steps that took more team work meetings that tooks HOURS  -  The ineffeciencies and every move and click you made were  constantly questioned. There was little trust or autonomy, even with the seasoned,tenured billers.      

I started with CMS shortly after finishing my fellowship training in Addiction Medicine. It's the only job I've had as an attending physician. Before I started working, a mentor told me "Most people don't like their first job, so expect that it won't be what you've pictured." My former co-resident physicians mostly don't like their jobs either, so I assumed it would probably be the same for me. All that to say, expectations were low. Happy to report: I love what I do. Working for CMS has been more than I ever envisioned being an attending physician could be. I practice evidence-based medicine in a environment where not one person has ever said the word "productivity" to me. My team operates within a harm reduction mindset, where patients are not punished for exhibiting the symptoms of an active substance use disorder. Our mission, vision, and values direct everything that we as an organization do. Rather than being an island, as being a physician often is, I get to bring difficult patient cases to an inter-disciplinary team including management, counseling, and clinical supervisors. As the medical director, if I want to make a policy change based on what I think is best for our patients, I just get to do it. I don't have to jump through bureaucratic hoops to do the right thing. Other CMS employees seek me out with community involvement opportunities, and I have the flexibility in my schedule to pursue them. I know without doubt, the work we do makes our community better. Lastly, CMS has invested in me. I've been given multiple leadership opportunities in a brief period of time, the resounding feedback given with them being "We believe in you." To summarize, if I could choose CMS again, I would choose it a thousand times over.

I loved this job for a good while. I felt appreciated and got to know the clients and felt appreciated by them as well. It was flexible when I had family emergencies or medical appointments and the PTO is pretty good. However moving into the counselor position changed things drastically. It seems apparent that the company as a whole puts more priority on putting more money in their pocket with little to no regard for best client care and little care for it's employees. It seems like the care I once received is no longer there after witnessing my coworkers be unsupported in awful personal and professional situations. My coworkers and most of the clients were probably the best part of the job and were what kept me there for as long as I was there. At times it definitely seems that the clients have more compassion for us staff than leadership does. I really wanted to love this job for a long time, unfortunately it seems that what many friends and told me were true-The pay was too good to be true, and likely meant there was a catch. I felt like I was given unrealistic expectations and was threatened to be terminated if I didn't meet their expectations, some of which were ultimately outside of my control. Do not plan on much structure or certainty for your day-You are expected to have a full schedule, of which clients may not show up on time or at all, and then are expected to drop everything for walk-in intakes. 

CMS is not a good place to work. The leadership is unsupportive, micro-manage without giving the clinic managers enough support to improve outcomes,  and belittling and cliquey leadership is well documented in their reviews and it's due to it being a systemic problem in their organization. This company is about making money and that's it. The quality of care is subpar and the clinics appear to be nothing more than methadone dispensaries. The person in charge of clinical is focused on the number of billing hours that each counselor completes - there is no real clinical supervision or growth for counselors thereby decreasing clinical care rather than improving it. The clinical director mainly goes to conferences to speak and does little else. The State of Wisconsin has blocked this agency from initiatives and it's for a reason - the quality of care does not meet the standards set by the State. I would not work here as a counselor, because you will not grow in your career, and you will not receive clinical supervision that is based upon client conceptualizations. Clinical supervision is centered around the number of billing hours you achieve. What I do love about CMS is that they do not penalize clients who are symptomatic unlike other opioid treatment programs; they have peer support specialists who work in corrections who are making a real impact with incarcerated clients; and they are committed to improving the community they are in with community initiatives and partnerships.

Community medical services is largely run by upper management who rarely spends time in the actual environment of Alaska clinics. The local team consists of some of the most caring and expert individuals that are truly fit for the substance abuse field. The technology for checking into the queue, app communication with clients, and training was admirable. 
I highly recommend documenting conversations subordinate employees have with upper management and asking for VERY clear expectations (specifically numbers and timelines) on tasks. If an individual does not “fit in” with higher level expectations, there are some concerning practices they use for conflict management.
As for job duties: counselors were expected to have a caseload of about 80 clients (reality was well over 100), to complete 3 full intake assessments per day (seasoned counselors know how out of touch this expectation is), and have 12 people on the schedule for counseling each day. When asked how to manage this, leaders suggested double booking, documentation while talking about sensitive information, or cutting sessions short to do documentation. No overtime allowed and PIP looming over everyone’s head if they could not manage. 
Personally, I did not appreciate the constant reminder of needing to produce enough to be worth the money they were paying me. 29/hour is not as high as they think it was compared to others. 

Community Medical Services is very committed to following its own established Mission, Vision, and Values along with dedicated to following the How We Work Together Norms. For an organization that is dependent on teamwork in order to provide the best quality of care for people impacted by opioid use this is critical for success. The organization provides several opportunities and avenues for professional growth as an individual. When it comes to reaching overall successes and providing best care for patients it is done with team effort.  Typical day at work is overseeing all the counseling and behavioral health in Wisconsin for all four clinics that are operational.  I have learned a significant amount about Harm Reduction and Medications for Opioid Use Disorder (MOUD) while working here.  The workplace culture strives to include voices of all employees, assuming positive intention, and one team is one calling.  The hardest part of the job is working in a professional that is susceptible to burnout and with overdoses occurring can be very challenging to practice self-care. 

What is the best part of working at the company?
The entire working environment was enriching. Helping individuals that are struggling and possibly at one of the lowest points in their life and seeing them come out the other side of that was amazing.

What is the most stressful part about working at the company?
I believe the most stressful part of the job for me was getting to know each patient and building a relationship with them and you would see them thriving and then they would fall off the wagon again or not show up for their dose. That was stressful because you knew what was possibly happening.

What is the work environment and culture like at the company?
For my experience, the environment and culture was very family. Like I mean, you sit down with the CEO the first week and you get to know him a little bit and you get to know your bosses closely and your co-workers. And again just from my experience it was very welcoming.

What is a typical day like for you at the company?
Your typical day starts around 4:30 or 5:30 in the morning and you're done with work by noon. Each day is different and has different events that occur. Just dealing with people in recovery. You never really know what's going to happen that day or what you're going to see. So if you're looking for an employer where each day is different and no 2 days are the exact same and also has a well -rounded working environment then this is the one.

Top Job Titles	Average Salary
Substance abuse counselor 48 salaries reported	$33.96 per hour
Licensed practical nurse 30 salaries reported	$38.03 per hour
Client services coordinator 26 salaries reported	$21.31 per hour
Nurse 11 salaries reported	$37.36 per hour
Clinic manager 8 salaries reported	$75,938 per year

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