Care Management Social Worker

Become a part of our caring community
 

Social Workers serve as specialist support for patients whose outcomes and utilization are driven by psychosocial complexity, including social instability, financial hardship, behavioral health concerns, caregiver strain, or difficulty navigating healthcare and social service systems. Scope includes but not limited to the following: 

• Socioeconomic and Psychosocial Assessment & Risk Identification 

• Conduct comprehensive psychosocial assessments addressing housing stability, food insecurity, transportation, financial stress, safety concerns, caregiver capacity, mental health or substance use factors, and health literacy (non diagnostic; screening only) 

• Identify socioeconomic barriers and psychosocial drivers contributing to poor adherence, frequent emergency department use, or avoidable hospitalizations 
• Social Needs Intervention & Resource Navigation 

• Support access to high‑barrier services and resources, including long‑term care, housing supports, and community‑based services 

• Assist with referrals, applications, documentation (per regulatory and compliance standards), and follow‑up 

• Coordinate across agencies and providers to address gaps impacting care stability and engagement 
• Behavioral Health Support  

• Provide short‑term, supportive, non-therapeutic interventions for patients coping with illness‑related distress, functional decline, or social instability 

• Screen for behavioral health or substance use concerns and facilitate referrals as indicated 

• Support patient engagement and activation with behavioral health services when recommended  
• Hospital & Emergency Department Follow‑Up (Psychosocial Focus) 

• Partner with the Care Team following hospitalizations or emergency department visits to address psychosocial barriers to recovery and follow‑up 

• Support stabilization and continuity of care to reduce avoidable readmissions or ED revisits 
• Collaboration with Care Team 

• Receive referrals when socioeconomic barriers and psychosocial complexity exceeds routine case coordination and familiarity or subject matter expertise of care coach supporting community and referral resource engagement 

• Provide assessment findings, recommendations, and follow‑through to support integrated care planning 

• Participate in high-risk rounds as appropriate (at minimum, for patients in own caseload) 

Duties and Responsibilities 

• Serve as the primary resource for complex socioeconomic barriers and psychosocial needs  

• Prioritize patients identified as having high psychosocial or social risk 

• Provide time‑limited, outcomes‑focused social work interventions 

• Coordinate with internal and external partners to secure services  

• Assist in mitigating crises that threaten care continuity or patient safety 

• Partner with Care Manager and PCP to ensure socioeconomic barriers and psychosocial needs are addressed 

• Follow organizational policies related to safety, documentation, and attendance 

Use your skills to make an impact
 

Required Qualifications 

• Master’s degree in Social Work (MSW) from an accredited program.  

• Licensure: Licensed or license‑eligible per state requirements. (LCSW welcome but not required) 

• Experience: Minimum 3 years of experience in clinical social work supporting patients, and their case coordination, across complex care clinical and community‑based services ecosystems 

• Experience working with high‑risk, medically complex or socially vulnerable populations 

• Demonstrated experience addressing health-related social needs and social determinants of health impacting patient outcomes, and system navigation to optimize patient resourcing and engagement in support of improve outcomes  

Preferred Qualifications 

• Experience addressing health related social needs (HRSNs) and social determinants of health (SDOH), including housing instability, food insecurity, transportation barriers, financial strain, access to benefits  

• Experience working with patients experiencing psychosocial complexity, such as caregiver stress, social isolation, elder abuse, chronic stress, grief, trauma related to illness, or difficulty coping with functional decline 

• Experience working with seniors or medically complex patients 

• Experience in population health or value‑based care models 

• Familiarity with resources and care coordination 

Skills / Abilities / Competencies 

• Strong psychosocial assessment and problem‑solving skills 

• Effective navigation of healthcare and social service systems 

• Excellent interpersonal, engagement, and communication skills 

• Cultural humility and patient‑centered approach 

• Ability to work independently within a lean clinical model 

• Strong organizational and documentation skills 

Workstyle 

• Workstyle: Hybrid; this role requires regular onsite presence in the clinics supported by the position. 

This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

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About Us
 

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.