Case Manager - Integrated Patient Care Program

• Supervise Social Workers and Community Health Workers, providing guidance, training, and performance support
• Coordinate patient referrals, follow-up, and care navigation across partner clinics and service providers
• Ensure consistent use of common intake, referral, and documentation processes
• Work with the Program Manager to implement program strategies related to social determinants of health, patient education, and telemedicine
• Support integration of community health workers and student interns into program operations
• Monitor patient progress and service utilization to support outcome measurement
• Serve as a day-to-day operational contact for partner agencies related to case management and referrals
• Participate in partner meetings and continuous improvement discussions
• Help identify gaps in services and opportunities to strengthen referral pathways
• Track case management activities, referrals, and patient outcomes
• Contribute to quarterly reviews of individual- and system-level outcomes
• Support documentation of best practices and program learnings for replication

• Bachelor’s degree required
• Minimum 3–5 years of experience in case management, care coordination, or community-based health services
• Experience supervising staff or leading frontline teams preferred
• Familiarity with social determinants of health, community resources, and patient navigation
• Strong interpersonal, organizational, and documentation skills
• Ability to work collaboratively across multiple organizations and disciplines

Master’s degree in Social Work, Public Health, or related field preferred