Care Coordinator, LSW (MSHO)

Bluestone Physician Services•Winona, MN
•Hybrid

About The Position

Bluestone is seeking a Care Coordinator to support Minnesota’s senior population in navigating healthcare and living healthier, more independent lives. The role manages Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) requirements for MSHO/MSC+ members within an assigned geographic area. It is hybrid, combining work from home with local travel to meet members in their homes and assisted living facilities. The position is based in Winona County areas, with approximately 50–70% of work involving community visits and 30–50% remote work. The Care Coordinator manages member caseloads, arranges services and resources, assesses members’ needs, and develops individualized care plans. The role also coordinates with medical care teams, supports members during care transitions, and completes required documentation. Full-time hours are 8:00 AM–5:00 PM Monday through Thursday and 8:00 AM–3:00 PM Friday. There are no evening, weekend, holiday, or on-call requirements. The salary range is $65,000–$75,000, commensurate with experience.

Requirements

  • Current Minnesota Licensed Social Worker credential (LSW, LMSW, LISW, or LICSW), or a Minnesota Registered Nurse license.
  • Valid driver’s license.
  • Ability to work independently.
  • Access to a private and compliant home office space.
  • Creative problem-solving skills.
  • Appreciation for working with diverse populations.
  • Effective communication skills, including strong verbal skills.
  • Excellent interpersonal and customer service skills.
  • Demonstrated compatibility with Bluestone’s mission and operating philosophies.
  • Ability to read, write, speak, and understand English.

Nice To Haves

  • One or more years of experience working with the geriatric or certified disabled population in case management/care coordination, home care, group homes, nursing homes, TCU, or assisted living settings.
  • New graduates are encouraged to apply.

Responsibilities

  • Manage member caseloads within an assigned geographic area.
  • Coordinate face-to-face visits.
  • Manage the Elderly Waiver.
  • Conduct annual assessments, including Personal Care Assistance (PCA) assessments for community members and customized living tools for members in assisted living facilities.
  • Review members’ current health needs, identify goals, and develop individualized care plans.
  • Connect members with community and state resources and services.
  • Help members remain safely in their homes and communities.
  • Complete required documentation.
  • Collaborate with medical care teams to ensure healthcare quality measures are met and use utilization management tools to meet value-based goals.
  • Support members during transitions of care and collaborate with their care teams to ensure safe discharge and follow-up plans.

Benefits

  • Health insurance
  • Dental insurance
  • Vision materials insurance
  • Company-paid life insurance
  • Company-paid short- and long-term disability
  • Health Savings Account with employer contribution
  • Flexible Spending Account (FSA)
  • Retirement plan with 4% matching contributions
  • Nine paid holidays for office closures plus one floating holiday
  • Three weeks (15 days) of paid time off
  • Mileage reimbursement program for field employees
  • Company-sponsored cell phone, laptop, and scrubs
  • Comprehensive six-month onboarding program
  • Dedicated preceptor support
  • Ongoing mentoring and coaching
  • Continuing education and professional development
  • Collaborative managers who work alongside employees
  • Experienced documentation auditors focused on education and quality
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