Complex Care Social Work Case Manager

Accountabilities: Build trusting relationships with patients through virtual and telephone interactions, providing compassionate, patient-centered social work support. Collaborate with physicians, nurse practitioners, case managers, community health workers, and outreach coordinators to deliver coordinated care for patients with complex needs. Identify social, socioeconomic, and logistical barriers affecting patients' health and well-being, and coordinate appropriate community resources and support services. Conduct psychosocial assessments and develop personalized action plans based on individual patient needs and circumstances. Identify caregivers experiencing burnout or managing significant care responsibilities, offering emotional support, guidance, and access to additional resources. Help patients and families navigate complex family dynamics, support systems, and challenging healthcare situations. Facilitate advance care planning and end-of-life discussions, including guidance around palliative care and hospice transitions when appropriate. Support long-term care planning by helping patients understand available options, coordinating referrals, and arranging necessary services. Coordinate with behavioral health teams and monitor patient outcomes to ensure continuity and effectiveness of care. Balance competing priorities across a complex patient population while maintaining consistent follow-up and timely support. Establish relationships with local community partners and internal stakeholders to strengthen care coordination and resource accessibility. Requirements Master's degree in Social Work (MSW) and an active social work license in the relevant state. At least 3 years of professional experience in medical social work, case management, or care coordination. Demonstrated experience building strong relationships with patients and collaborating effectively with multidisciplinary healthcare teams. Ability to work in a fast-paced, evolving healthcare environment and adapt to changing priorities and technologies. Strong interpersonal, communication, and active listening skills, with the ability to explain complex information clearly to patients, caregivers, and healthcare professionals. Excellent organizational and multitasking abilities, including managing competing demands, documenting interactions, and coordinating multiple care needs simultaneously. Strong problem-solving skills and a proactive approach to identifying barriers, navigating logistical challenges, and connecting patients with appropriate resources. Compassionate, empathetic, and patient-focused mindset, with a genuine commitment to improving healthcare access and outcomes. Ability to work independently in a fully remote environment while remaining reliable, responsive, and collaborative. Comfort with digital healthcare platforms and new technologies. Preferred qualifications: Bilingual proficiency in Spanish. Experience with health insurance, particularly Medicare Advantage. Previous experience working with older adults and senior populations. Familiarity with complex care management and community-based healthcare resources. Benefits Annual salary: $65,000–$85,000, depending on qualifications, experience, skills, and location. Employer-sponsored medical, dental, and vision insurance, with low or no employee premiums. Generous paid time off. Monthly $100 mobile phone or internet stipend. Stock options available to all employees. Bonus eligibility for applicable positions. Parental leave program. 401(k) retirement savings program. Remote working opportunities. Opportunity to contribute to meaningful improvements in healthcare delivery and patient outcomes. Collaborative environment alongside multidisciplinary healthcare professionals. Opportunities for professional growth and development within an innovative healthcare organization.