Care Manager - Social Worker (SW)
for headings. Use - for any list of duties/requirements/benefits. Use
for prose.
We need to parse the job description.
Let's extract content:
Job Description: Care Manager, Social Worker Monogram Health is seeking a Social Worker to join our integrated in-home care teams, working alongside Nurse Care Managers and Advanced Practice Providers. Our patients often face complex chronic medical conditions coupled with behavioral health challenges, making the social worker a critical clinical expert within the care team. In this role, social workers practice with a high degree of autonomy. Responsibilities include assessing patients' behavioral, social, and environmental needs; utilizing validated screening tools; identifying behavioral health concerns; determining when clinical intervention is warranted; and serving as a trusted behavioral health resource for fellow clinicians. Because this position requires independent clinical judgment and practice, the successful candidate will hold an active, unrestricted LCSW license in the state of employment. Social workers who require ongoing clinical supervision to practice independently, including those at the master's or associate level pursuing full licensure, are not eligible for this role. This is a unique opportunity to apply advanced clinical social work skills within a multidisciplinary, home-based care model focused on improving outcomes for some of the highest-need patients in healthcare. Your Impact The care team works with patients face-to-face, over the phone, and through telehealth to identify and address social determinants of health. The goal is to build a patient’s social support network, navigate behavioral challenges, and generally help patients through a traumatic diagnosis and life-changing disease. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. Highlights & Benefits Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources Time Off & Leave – 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts Compensation The base salary range for this role is $83,554 to $102,825 and reflects the range of experience and qualifications we may consider. Final compensation will be determined based on geographic location and job-related factors such as experience, skills, education, certifications, and internal compensation considerations. While a larger range is posted, most offers will typically fall within a narrower band based on these factors. In addition to base salary, this role is eligible for additional compensation, including bonus opportunities and a comprehensive benefits package. Roles And Responsibilities Perform in-home and telehealth care management visits to assess and determine social and behavioral status Work closely with Care Team to ensure collaboration and optimal patient outcomes Assess social determinants of health needs and develop a plan for addressing them Identify, vet, and build relationships with local Community-Based Organizations Educate patients on appropriate resources, assist with referral completion, and follow up for closure outcomes Serve as subject matter expert on social determinants for other members of the Care Team Complete behavioral, environmental, and social support assessments Deliver individual, family and group education on living with chronic illness Engage family and social support groups in the education and care of patients Assess patients and refer to behavioral health specialists if diagnosis and treatment needed Help patients to understand, accept and follow medical and lifestyle recommendations Review and document patient updates and progress in care management platform Position Requirements This position involves telephonic visits with some car travel to patients’ homes Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding. Currently licensed as a LCSW in the posted state Master’s degree in social work and passed ASWB masters or clinical exam Rare domestic travel may be required to Brentwood, TN Self-starter with the ability to work independently with minimal supervision Ability to show empathy and quickly build relationships with patients and local CBOs Preferred 2+ years previous experience working in care management and/or with chronic illness Excellent verbal communication skills both in person and on the phone Familiarity with Microsoft Office and mobile phone and web-based applications About Monogram Health Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
We need to create sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to decide which sections have content.
- About the role: Could be the initial description about the role, maybe the first paragraph(s) describing the role, purpose, impact. We'll include a prose paragraph summarizing the role.
- Responsibilities: There's a "Roles And Responsibilities" list. Also earlier "Responsibilities include assessing patients...". We'll combine into a list.
- Requirements: There's "Position Requirements" list (BLS, LCSW license, Master's degree, etc). Also "Preferred" items maybe under Skills? We'll treat Requirements as mandatory.
- Qualifications: Could be education/license etc. Might overlap with Requirements. But we need to decide: maybe Requirements = mandatory qualifications; Qualifications = preferred? However guidelines: Use sections only when posting has real specific content. We have both mandatory and preferred items. Could put mandatory under Requirements, preferred under Skills or Qualifications. Let's map:
Mandatory: BLS certification, active unrestricted LCSW license, Master's degree in social work and passed ASWB masters or clinical exam, ability to work independently, self-starter, ability to show empathy, etc. Also telephonic visits with some car travel.
Preferred: 2+ years experience in care management/chronic illness, excellent verbal communication skills, familiarity with Microsoft Office etc.
We could put mandatory under Requirements, preferred under Skills.
Qualifications maybe education/license: but we already have that in Requirements. Could combine. But we need to avoid thin sections. Perhaps we can have Requirements (mandatory) and Skills (preferred). Qualifications maybe not needed if content overlaps. But we need to include sections only if posting has real specific content. We have content for Requirements and Skills. For Qualifications maybe we could put education/license as qualifications. But that would duplicate. Better to have Requirements (mandatory) and Skills (preferred). Qualifications maybe not needed.
Benefits: We have "Highlights & Benefits" with bullet points: Comprehensive Benefits..., Financial & Retirement Support..., Time Off & Leave..., Wellness & Growth... We'll list as
- .
Pay: Compensation section includes base salary range $83,554 to $102,825, plus bonus opportunities. That's specific. So include Pay.
Schedule: Not explicitly mentioned. There's mention of telephonic visits, some car travel, rare domestic travel to Brentwood, TN. No explicit schedule like full-time, part-time, shift. So we should not create Schedule section because no specific schedule content.
Thus sections: About the role, Responsibilities, Requirements, Skills, Benefits, Pay.
We need to output HTML fragment only, no /. Use
for each heading. Use
for prose. Use
- for lists.
We must not repeat job title as heading. So headings are just the section names.
Let's craft content.
About the role: prose summarizing role: Monogram Health seeking Social Worker to join integrated in-home care teams, working with Nurse Care Managers and Advanced Practice Providers; role involves assessing behavioral, social, environmental needs; using screening tools; providing trusted behavioral health resource; high autonomy; requires active unrestricted LCSW license; independent clinical judgment; opportunity to apply advanced clinical social work skills in multidisciplinary home-based care model focusing on high-need patients; impact includes addressing social determinants of health, building support network, navigating behavioral challenges, helping patients through traumatic diagnosis.
We'll write a couple sentences.
Responsibilities: list items from "Roles And Responsibilities" plus earlier responsibilities. Let's compile unique items:
- Perform in-home and telehealth care management visits to assess and determine social and behavioral status
- Work closely with Care Team to ensure collaboration and optimal patient outcomes
- Assess social determinants of health needs and develop a plan for addressing them
- Identify, vet, and build relationships with local Community-Based Organizations
- Educate patients on appropriate resources, assist with referral completion, and follow up for closure outcomes
- Serve as subject matter expert on social determinants for other members of the Care Team
- Complete behavioral, environmental, and social support assessments
- Deliver individual, family and group education on living with chronic illness
- Engage family and social support groups in the education and care of patients
- Assess patients and refer to behavioral health specialists if diagnosis and treatment needed
- Help patients to understand, accept and follow medical and lifestyle recommendations
- Review and document patient updates and progress in care management platform
- Assess patients' behavioral, social, and environmental needs (maybe duplicate)
- Utilize validated screening tools
- Identify behavioral health concerns
- Determine when clinical intervention is warranted
- Serve as trusted behavioral health resource for fellow clinicians
We can combine but avoid duplication. We'll create a list merging.
Requirements (mandatory): list:
- Basic Life Support (BLS) certification required (company supports completion through onboarding)
- Active, unrestricted LCSW license in the state of employment
- Master’s degree in social work and passed ASWB masters or clinical exam
- Ability to work independently with minimal supervision (self‑starter)
- Ability to show empathy and quickly build relationships with patients and local CBOs
- Position involves telephonic visits with some car travel to patients’ homes
- Rare domestic travel may be required to Brentwood, TN
Skills (preferred/experience): list:
- 2+ years previous experience working in care management and/or with chronic illness
- Excellent verbal communication skills both in person and on the phone
- Familiarity with Microsoft Office and mobile phone and web‑based applications
Benefits: list from Highlights & Benefits:
- Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
- Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
- Time Off & Leave – 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave
- Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts
Pay: prose: base salary range $83,554 to $102,825; final compensation based on geographic location, experience,
for prose. We need to parse the job description. Let's extract content: Job Description: Care Manager, Social Worker Monogram Health is seeking a Social Worker to join our integrated in-home care teams, working alongside Nurse Care Managers and Advanced Practice Providers. Our patients often face complex chronic medical conditions coupled with behavioral health challenges, making the social worker a critical clinical expert within the care team. In this role, social workers practice with a high degree of autonomy. Responsibilities include assessing patients' behavioral, social, and environmental needs; utilizing validated screening tools; identifying behavioral health concerns; determining when clinical intervention is warranted; and serving as a trusted behavioral health resource for fellow clinicians. Because this position requires independent clinical judgment and practice, the successful candidate will hold an active, unrestricted LCSW license in the state of employment. Social workers who require ongoing clinical supervision to practice independently, including those at the master's or associate level pursuing full licensure, are not eligible for this role. This is a unique opportunity to apply advanced clinical social work skills within a multidisciplinary, home-based care model focused on improving outcomes for some of the highest-need patients in healthcare. Your Impact The care team works with patients face-to-face, over the phone, and through telehealth to identify and address social determinants of health. The goal is to build a patient’s social support network, navigate behavioral challenges, and generally help patients through a traumatic diagnosis and life-changing disease. Your gifts as a healthcare professional are urgently needed. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do. Highlights & Benefits Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources Time Off & Leave – 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts Compensation The base salary range for this role is $83,554 to $102,825 and reflects the range of experience and qualifications we may consider. Final compensation will be determined based on geographic location and job-related factors such as experience, skills, education, certifications, and internal compensation considerations. While a larger range is posted, most offers will typically fall within a narrower band based on these factors. In addition to base salary, this role is eligible for additional compensation, including bonus opportunities and a comprehensive benefits package. Roles And Responsibilities Perform in-home and telehealth care management visits to assess and determine social and behavioral status Work closely with Care Team to ensure collaboration and optimal patient outcomes Assess social determinants of health needs and develop a plan for addressing them Identify, vet, and build relationships with local Community-Based Organizations Educate patients on appropriate resources, assist with referral completion, and follow up for closure outcomes Serve as subject matter expert on social determinants for other members of the Care Team Complete behavioral, environmental, and social support assessments Deliver individual, family and group education on living with chronic illness Engage family and social support groups in the education and care of patients Assess patients and refer to behavioral health specialists if diagnosis and treatment needed Help patients to understand, accept and follow medical and lifestyle recommendations Review and document patient updates and progress in care management platform Position Requirements This position involves telephonic visits with some car travel to patients’ homes Basic Life Support (BLS) certification is required in this role. The company will support your certification completion through onboarding. Currently licensed as a LCSW in the posted state Master’s degree in social work and passed ASWB masters or clinical exam Rare domestic travel may be required to Brentwood, TN Self-starter with the ability to work independently with minimal supervision Ability to show empathy and quickly build relationships with patients and local CBOs Preferred 2+ years previous experience working in care management and/or with chronic illness Excellent verbal communication skills both in person and on the phone Familiarity with Microsoft Office and mobile phone and web-based applications About Monogram Health Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum. We need to create sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which sections have content. - About the role: Could be the initial description about the role, maybe the first paragraph(s) describing the role, purpose, impact. We'll include a prose paragraph summarizing the role. - Responsibilities: There's a "Roles And Responsibilities" list. Also earlier "Responsibilities include assessing patients...". We'll combine into a list. - Requirements: There's "Position Requirements" list (BLS, LCSW license, Master's degree, etc). Also "Preferred" items maybe under Skills? We'll treat Requirements as mandatory. - Qualifications: Could be education/license etc. Might overlap with Requirements. But we need to decide: maybe Requirements = mandatory qualifications; Qualifications = preferred? However guidelines: Use sections only when posting has real specific content. We have both mandatory and preferred items. Could put mandatory under Requirements, preferred under Skills or Qualifications. Let's map: Mandatory: BLS certification, active unrestricted LCSW license, Master's degree in social work and passed ASWB masters or clinical exam, ability to work independently, self-starter, ability to show empathy, etc. Also telephonic visits with some car travel. Preferred: 2+ years experience in care management/chronic illness, excellent verbal communication skills, familiarity with Microsoft Office etc. We could put mandatory under Requirements, preferred under Skills. Qualifications maybe education/license: but we already have that in Requirements. Could combine. But we need to avoid thin sections. Perhaps we can have Requirements (mandatory) and Skills (preferred). Qualifications maybe not needed if content overlaps. But we need to include sections only if posting has real specific content. We have content for Requirements and Skills. For Qualifications maybe we could put education/license as qualifications. But that would duplicate. Better to have Requirements (mandatory) and Skills (preferred). Qualifications maybe not needed. Benefits: We have "Highlights & Benefits" with bullet points: Comprehensive Benefits..., Financial & Retirement Support..., Time Off & Leave..., Wellness & Growth... We'll list as
- .
Pay: Compensation section includes base salary range $83,554 to $102,825, plus bonus opportunities. That's specific. So include Pay.
Schedule: Not explicitly mentioned. There's mention of telephonic visits, some car travel, rare domestic travel to Brentwood, TN. No explicit schedule like full-time, part-time, shift. So we should not create Schedule section because no specific schedule content.
Thus sections: About the role, Responsibilities, Requirements, Skills, Benefits, Pay.
We need to output HTML fragment only, no /. Use
for each heading. Use
for prose. Use
- for lists. We must not repeat job title as heading. So headings are just the section names. Let's craft content. About the role: prose summarizing role: Monogram Health seeking Social Worker to join integrated in-home care teams, working with Nurse Care Managers and Advanced Practice Providers; role involves assessing behavioral, social, environmental needs; using screening tools; providing trusted behavioral health resource; high autonomy; requires active unrestricted LCSW license; independent clinical judgment; opportunity to apply advanced clinical social work skills in multidisciplinary home-based care model focusing on high-need patients; impact includes addressing social determinants of health, building support network, navigating behavioral challenges, helping patients through traumatic diagnosis. We'll write a couple sentences. Responsibilities: list items from "Roles And Responsibilities" plus earlier responsibilities. Let's compile unique items: - Perform in-home and telehealth care management visits to assess and determine social and behavioral status - Work closely with Care Team to ensure collaboration and optimal patient outcomes - Assess social determinants of health needs and develop a plan for addressing them - Identify, vet, and build relationships with local Community-Based Organizations - Educate patients on appropriate resources, assist with referral completion, and follow up for closure outcomes - Serve as subject matter expert on social determinants for other members of the Care Team - Complete behavioral, environmental, and social support assessments - Deliver individual, family and group education on living with chronic illness - Engage family and social support groups in the education and care of patients - Assess patients and refer to behavioral health specialists if diagnosis and treatment needed - Help patients to understand, accept and follow medical and lifestyle recommendations - Review and document patient updates and progress in care management platform - Assess patients' behavioral, social, and environmental needs (maybe duplicate) - Utilize validated screening tools - Identify behavioral health concerns - Determine when clinical intervention is warranted - Serve as trusted behavioral health resource for fellow clinicians We can combine but avoid duplication. We'll create a list merging. Requirements (mandatory): list: - Basic Life Support (BLS) certification required (company supports completion through onboarding) - Active, unrestricted LCSW license in the state of employment - Master’s degree in social work and passed ASWB masters or clinical exam - Ability to work independently with minimal supervision (self‑starter) - Ability to show empathy and quickly build relationships with patients and local CBOs - Position involves telephonic visits with some car travel to patients’ homes - Rare domestic travel may be required to Brentwood, TN Skills (preferred/experience): list: - 2+ years previous experience working in care management and/or with chronic illness - Excellent verbal communication skills both in person and on the phone - Familiarity with Microsoft Office and mobile phone and web‑based applications Benefits: list from Highlights & Benefits: - Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts - Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources - Time Off & Leave – 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave - Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts Pay: prose: base salary range $83,554 to $102,825; final compensation based on geographic location, experience,