LCSW Care Manager-Population Management

UNC Health•Chapel Hill, NC

1d•Hybrid

About The Position

The LCSW Care Manager is embedded in a primary care clinic in Chapel Hill and is part of the Population Management team. The role provides integrated behavioral health services, Annual Wellness Visits, and preventive care, building trusted patient relationships, addressing behavioral health needs, supporting long-term health and wellness goals, and helping patients navigate care beyond traditional office visits. The position provides psychotherapy, biopsychosocial assessments, individualized patient-centered care plans, crisis intervention, resource connections, advocacy, and ongoing monitoring of care-plan progress. The Care Manager collaborates with patients and the interdisciplinary healthcare team to coordinate holistic care and support effective transitions. The role also includes accurate service documentation and billing, active participation in meetings and quality-improvement initiatives, and identifying and escalating opportunities to improve quality and patient satisfaction. This is a full-time, hybrid position with a Monday–Friday, 8:00 AM–5:00 PM day schedule, an hour for lunch, and four hours of administrative time each week. The role has no nights, major holidays, or on-call responsibilities. AI scribing support is available within the EHR.

Requirements

Master’s degree in Social Work.
Licensure or certification as a Clinical Social Worker (LCSW).
At least 2 years of experience as a fully licensed LCSW in an outpatient setting.
Knowledge of mental health conditions, diagnostic criteria, and evidence-based treatment modalities.
Strong assessment and diagnostic skills.
Excellent counseling and interpersonal skills.
Ability to collaborate effectively as part of an interdisciplinary team.
Empathy, compassion, and cultural sensitivity.
Strong organizational and time-management skills, including the ability to manage competing priorities and adapt as patient needs change.
Ability to maintain confidentiality and adhere to ethical guidelines.
Proficiency in billing and documentation procedures.
Strong communication, clinical judgment, collaboration, and problem-solving skills.
Ability to thrive in a fast-paced, evolving environment.

Responsibilities

Provide individual, group, and family psychotherapy using evidence-based therapeutic techniques and interventions.
Document and bill for services accurately in compliance with insurance and regulatory requirements.
Conduct comprehensive biopsychosocial assessments of patient needs, support systems, coping mechanisms, mental health conditions, and psychosocial factors.
Collaborate with patients and the healthcare team to develop individualized care plans that address patient needs, goals, and preferences and integrate medical, psychological, and social care.
Facilitate care transitions and help prevent unnecessary hospitalizations or emergency department use.
Connect patients and families with community resources, mental health services, support groups, and other relevant programs.
Assist with referrals for psychiatric evaluations and medication management, and coordinate care with other providers.
Identify actual or potential patient and family crises; provide crisis intervention and emotional support; and develop and facilitate plans for resolution.
Monitor and evaluate patient progress and outcomes, adjust care plans as needed, and collaborate with the healthcare team on follow-up and continuity of care.
Advocate for patients’ needs and access to treatment, facilitate communication with the healthcare team, and address barriers to well-being.
Use active listening and provide a safe, non-judgmental space with empathy, validation, and support.
Respect patients’ individual values, beliefs, cultural backgrounds, and preferences when tailoring interventions and support.
Build trust-based relationships with patients and families through empathy, confidentiality, professionalism, and open communication.
Participate in meetings, problem solving, goal setting, quality-improvement, and patient-satisfaction initiatives; identify and appropriately escalate quality-improvement opportunities.
Build patient relationships, address behavioral health needs, support wellness goals, and help patients navigate care beyond traditional office visits.