Social Worker – Care Coordination, Population Health

🕒 August 6

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $26 - $41 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 36%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Bon Secours

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

Bon Secours is a mission-driven, not-for-profit health care organization that emphasizes compassionate, community-focused clinical care and support services. The organization recruits and trains staff for bedside care, patient support, community service, and administration, and highlights workforce development, flexible benefits, and a culture centered on dignity, unity, and service. Bon Secours presents itself as a faith-based/ministry-oriented health system focused on serving patients and communities with an emphasis on employee growth and total rewards.

📋 Description

• Provide clinical care management services to identified eligible patients • Coordinate care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care • Work as a member of the Interdisciplinary Team with the Ambulatory Care Manager and Care Coordinator • Perform standardized comprehensive needs assessments • Identify and address barriers to care and align patients with available benefits and resources • Maintain a caseload of patients according to department policies • Identify, enroll and manage patients in the Complex Case Management program • Develop, implement, review and update care plans • Collaborate with ACMs, PCPs, Specialists and Hospitalists on patient-centered care plans • Perform situational and family assessments of social determinants of care • Conduct patient outreach and document in the electronic medical record • Identify, execute and track referrals to care and community resources • Provide resource management to improve care and patient experience and reduce unnecessary cost and utilization • Assist patients with advanced care planning and Advanced Directives • Document communications with patients and care teams in the electronic medical record • Coordinate services for disabled status and facilitate placement in post-acute rehabilitation or long-term care facilities • Advocate for patients and connect them with appropriate community resources and services

🎯 Requirements

• Bachelor's Degree (required) • Licensure as required by state of practice (required) • 2-3 years acute care, home health or case management experience • Excellent interpersonal communication and negotiation skills • Strong analytical, data management and computer skills • Basic knowledge of healthcare and health education across the lifespan in a practice health setting • Ability to work with individuals, groups and families • Familiarity and knowledge of Community Resources • Flexibility to work non-traditional hours • Personal computer skills • Experience with database entry and EMR documentation • Basic Excel skills • Highly organized and detail oriented • Accepts responsibility and follows through on projects and activities • VA state license required • Case Management certification, LSW or LCSW preferred • Bachelor's or Master's Degree in Social Work preferred • PowerPoint experience preferred

🏖️ Benefits

• Competitive pay • Incentives • Referral bonuses • 403(b) with employer contributions (when eligible) • Medical coverage • Dental coverage • Vision coverage • Prescription coverage • HSA/FSA options • Life insurance • Mental health resources and discounts • Paid time off • Parental leave • FMLA leave • Short- and long-term disability • Backup care for children and elders • Tuition assistance • Professional development • Continuing education support