Social Work Care Coordinator

Baltimore Corps - Baltimore, MD

Supervises the Care Coordination Associate and also provides education and reinforcement about Medicaid benefits and system navigation, assistance with addressing barriers to healthcare and linkage to their HealthChoice Managed Care Organization, Primary Care Provider and Specialty care with HealthCare Access Maryland.


Job summary:

This job is part of a temporary citywide corps, Baltimore Health Corps, that is being created to address the economic and public health crises caused by COVID-19. Jointly led by the Baltimore City Health Department and the Mayor’s Office of Employment Development, the initiative will train and employ hundreds of residents in a time of record unemployment while supporting the city’s emergency public health response. The corps includes a contract tracing/community outreach team and a care coordination team.

Applicants who are hired for this position will undergo training that allows them to learn the fundamental principles of becoming a community health worker in addition to understanding fundamental roles of contact tracing and public health outreach. In addition, the Mayor’s Office of Employment Development will provide job coaching to assist with the transition to permanent employment, as this is a temporary position. Legal and mental health services will also be available to all Baltimore Health Corps employees.

The Care Coordination Program is an outreach and short-term care coordination program within HealthCare Access Maryland. The Care Coordination mission, as detailed by Maryland’s Medicaid Managed Care Program known as HealthChoice, is to outreach and provide community-based, client focused services to the following groups: non-compliant Medicaid recipients, pregnant and postpartum women, newborns and children under age 2, children and adults with special health needs, and family planning recipients.

Licensed Social Work Care Coordinator will provide short term care coordination services to individuals and families. The Social Work Care Coordinator will be responsible for assessing, coordinating services, and partnering with community resources to address the needs of an assigned population. To provide support and expertise through assessment, planning, implementation and overall evaluation of the individual client needs.


Key duties & responsibilities

  • Conduct home and telephone assessments to provide linkage and coordination to prenatal care, primary care, dental care, specialty care, preventive health screenings, lead screenings and immunizations.

  • Work as a Team Leader to support outreach staffers with outreach strategies, client engagement and care coordination interventions

  • Co-facilitate team meetings to provide consultation for medically complex cases, general case discussion for sharing of best practices and resources.

  • Develop and facilitate services that provide education, screening and advanced assessments for the Maryland Medicaid recipient population residing in Baltimore City.

  • Provide education, assistance and care coordination services to high-risk pregnant women and infants, referred clients that have experienced an infant or child loss, as well as clients with complex medical and/or psychosocial needs.

  • Assess prenatal clients’ risk and eligibility for referral to Baltimore City’s network of home visiting programs according to established vulnerability index criteria/guidelines.

  • Provide appropriate resource linkage to programs and services such as WIC, MCO case management, Safe Sleep, car seat assistance, etc., that assist pregnant/postpartum women and families in Baltimore City.

  • Consult with other community agencies to identify potential resources for resolving client’s health, psychosocial or financial problems.

  • Deploy various methods for locating referred clients that are difficult to locate; establishing liaisons with DSS, PCP’s, neighbors, churches, and other community groups.

  • Develop and implement methods for coordinating and evaluating coordination services that are carried out in diverse settings such as client homes, public agencies, churches, community-based organizations, etc.

  • Function as a liaison to external agencies and shares information with others, which may impact care and/or services of clients and referral services.

  • Participate in staff, community, professional and inter-agency meetings and conferences.

  • Document client assessments, activity, treatment plans and resolutions; prepares narrative and statistical reports.

  • Perform other appropriate duties as assigned.


Preferred qualifications

  • Excellent oral and written skills

  • Excellent organizational and communication skills

  • Excellent problem solving skills

  • Ability to work efficiently and meet deadlines

  • Proficiency with MS Word, Excel, Outlook and SharePoint (365).

  • Ability to handle confidential information with discretion and professionalism

  • Ability to exhibit a professional, positive attitude and work ethic

  • Critical thinking and sound judgment



  • Bachelor’s degree in social work

  • Current licensure as a Social Worker in the State of Maryland.

  • At least one year of related experience

  • Relevant clinical experience providing services to pregnant women and/or infants, preferably in a public health/community setting.


Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk, hear, and respond to customers and employees. The employee frequently is required to stand; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee is occasionally required to walk 3 blocks or more and sit for prolonged periods of time. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Safety & Health Responsibilities

HCAM is committed to providing and maintaining a safe, secure and healthy work environment for all employees, clientsserved, volunteers and visitors. As part of this commitment, HCAM has developed safety, security and occupational health policies, practices, and standards.

With this understanding, all employees are required to: Adhere to all local, state and federal safety and environmental codes, ordinances, standards and laws; adhere to all HCAM and local safety plans, policies, practices and standards; be aware of and follow all safety rules of your work site; report any unsafe conditions or accidents to your supervisor; practice standard precautions (formerly universal precautions) at all times, and; participate in mandatory or available safety training.


This position will be a temporary contractual position and will include a health insurance stipend.

Posted On: Thursday, June 4, 2020
Compensation: $60,000.00 per year

Tagged: Social Work

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