Primary Care Social Work Case Manager

Devoted Health•Waltham, MA

3d•$65,000 - $85,000•Remote

About The Position

Devoted Medical seeks a social work case manager to support its Primary Care program by addressing patients’ psychosocial needs as part of an interdisciplinary team. The role supports vulnerable patients, including people with chronic conditions who may lack access to high-quality care, through a virtual care platform that combines remote monitoring, automated medication management, and disease education. The position provides case management through telephonic and video visits with patients and caregivers, psychosocial screenings, personalized care plans, emotional and caregiver support, and navigation of behavioral health, long-term care, advance care planning, and social determinants of health. The case manager collaborates with clinicians, nurses, care coordinators, families, caregivers, and other stakeholders to coordinate patient-centered care. The role also participates in team huddles, panel reviews, interdisciplinary rounds, and program development, and documents clinical interactions in the electronic health record. The organization describes a fast-paced, changing, collaborative work environment and seeks someone who can work independently from home, use technology comfortably, and communicate with patients by phone and video. The stated salary range is $65,000–$85,000 per year. Total rewards for full-time employees include health, dental, and vision plans; paid time off; a monthly mobile or internet stipend; stock options; bonus eligibility; parental leave; and a 401(k) program.

Requirements

Master’s degree in social work and an active license.
At least 2 years of expertise in the medical field.
Comfort with technology and a fast-paced environment.
Ability to work as a self-starter in a work-from-home environment.
Strong interpersonal and communication skills.
Comfort working with patients over video and phone.

Nice To Haves

Bilingual in English and Creole, Spanish, or Vietnamese.
Experience in health insurance; Medicare Advantage experience is a plus.
Experience in geriatrics.
Compassion, empathy, and warmth in helping people improve their health and navigate the healthcare system.
Problem-solving ability and skill in breaking down barriers.
Ability to connect with people quickly and follow up persistently.
Passion for improving healthcare and serving patients.
Ability to adjust communication tone and approach to different people and explain complex information clearly.
Reliability, punctuality, and dependability for members and teammates.
Ability to adapt to a changing environment, move quickly, and communicate transparently about progress and challenges.
Enjoyment of fast-paced, high-energy work and willingness to collaborate and adapt as the organization changes.
Comfort engaging with and learning technologies, including electronic health records, operating systems, Google Office, and Slack.
Willingness to learn from experience and accept failure as part of learning.

Responsibilities

Conduct telephonic and video visits with patients and caregivers.
Establish trust and build strong relationships with patients.
Collaborate with clinicians, nurses, care coordinators, and other teammates to provide cohesive, patient-centered care for high-needs patients.
Conduct social work case management interventions to maximize program effectiveness.
Complete psychosocial screenings and create personalized care plans tailored to patients’ needs.
Provide emotional and caregiver support and help navigate family and caregiver support.
Address social determinants of health and social drivers of utilization.
Support behavioral health navigation, long-term care planning, and advance care planning.
Balance multiple competing priorities from patients.
Work with family members and caregivers to help them understand patients’ needs and how to support them.
Facilitate and participate in joint visits.
Participate in team huddles, panel reviews, interdisciplinary team rounds, and program and role growth and development.
Build relationships and coordinate with key local market and internal stakeholders.
Document all clinical interactions in the electronic health record.