Sr. Social Care Specialist

Role Type: Sr. Social Care Specialist (Bilingual Preferred)Reports To: Social Care ManagerLocation: HybridSalary: Commensurate with experience

About Us

CareAdvisors is a social care management organization dedicated to connecting individuals and families with the healthcare and social service benefits they need. We transform inefficient care coordination processes through innovative technology and community-based solutions, improving health outcomes for underserved populations.

About the Role

We are seeking an experienced Senior Social Care Specialist to provide advanced, high-acuity case management services for individuals with significant health, behavioral, and social needs.

This is an advanced individual contributor role focused on complex case management, intensive resource coordination, SNF/SMRF placement support, appeals, and navigating multiple systems of care. The Senior Social Care Specialist maintains a specialized caseload of complex cases and serves as a subject-matter resource.

The ideal candidate has experience working within an extensive hospital system, a medium-sized FQHC, or a managed care organization/health plan.

Core Responsibilities

Complex Case Management and Customer Support

• Manage a dedicated caseload of high-acuity, complex cases involving significant medical, behavioral health, or social determinants of health needs.
• Coordinate escalated care scenarios, including hospital discharges, SNF and SMRF placements, rehabilitation transitions, and benefit-related issues.
• Conduct comprehensive clinical and SDoH assessments to identify barriers related to housing, food access, safety, income support, and healthcare continuity.
• Develop individualized care plans in collaboration with clients, caregivers, providers, and community partners.
• Navigate Medicaid, SNAP, housing, disability supports, and other public benefit programs.
• Collaborate with hospitals, MCOs, FQHCs, behavioral health providers, and social service agencies to resolve barriers to care.
• Support members through appeals, denials, redeterminations, and complex eligibility issues.
• Maintain accurate, timely documentation in EHR and case management systems in accordance with internal and partner standards.

Client Advocacy and Intensive Support

• Serve as an advocate for clients facing health, behavioral, or SDoH-related challenges.
• Provide education and systems navigation support for clients, families, and caregivers.
• Coordinate closely with MCO case managers, hospital discharge teams, SNF administrators, and community partners to ensure continuity of care.
• Deliver culturally competent and trauma-informed communication.

Collaboration and Subject Matter Support (Non-Supervisory)

• Act as a resource for staff regarding SNF/SMRF workflows, hospital discharge processes, benefit eligibility, and complex systems navigation.
• Participate in case reviews, quality meetings, and workflow discussions.
• Share insights on emerging trends and opportunities to improve workflows.

Operational Excellence and Compliance

• Meet or exceed productivity, quality, and documentation expectations.
• Follow company policies, HIPAA reqs, Medicaid/MCO requirements, and partner protocols.
• Demonstrate strong judgment, professionalism, and accountability in managing a high-complexity caseload.
• Perform other duties as assigned that support organizational effectiveness and mission delivery.

Qualifications

• Master's degree in Social Work, Counseling, Public Health, Healthcare Administration, Psychology, Human Services, or a related field; or commensurate experience.
• 4+ yrs experience in social care coordination, complex case mgmt, or managed care settings.
• Experience working in large hospital systems, medium-sized FQHCs, or MCOs/health plans.
• Expertise in managing complex, multi-system cases and high-acuity member needs.
• Strong knowledge of Medicaid, SNAP, housing programs, transportation benefits, and other essential services.
• Expert coordinator care across hospitals, SNFs, SMRFs, MCOs, and community-based providers.
• Excellent written and verbal communication, documentation, and organizational skills.
• Ability to work independently, manage competing priorities, and adapt in a fast-paced environment.
• Proficiency with Microsoft Office, Google Workspace, and EHR/case management platforms.
• Reliable transportation, a valid driver's license, and proof of insurance.

Preferred

• Clinical licensure is a plus.
• Experience with Accountable Care Organizations (ACO), Managed Care Organizations (MCO), or other value-based care environments.
• Familiarity with Illinois and/or Wisconsin healthcare and social service systems.
• Experience supporting clients through Placements, appeals, or denials related to benefits.

At Care Advisors, we value diversity and endeavor to treat everyone with respect, regardless of age, gender, race, ethnicity, or sexual, cultural, or ideological preferences.