SOCIAL WORK NAVIGATOR

Job Description

Job Description

Social Work Navigator/Case Manager (MSW/BSW License/Limited License)

Are you a licensed Social Worker looking for a meaningful role that offers autonomy, flexibility, and the opportunity to make a real impact in your community? TANDEM365 is seeking a Social Work Navigator (MSW or BSW – Licensed or Limited License) to serve the Grand Rapids / Kent County area as part of our innovative, community-based care model.

• Predictable Schedule – Monday–Friday, 8:00am–4:30pm , with the option to transition after 90 days to four 10-hour days (7:30am–6:00pm)
• No On-Call Requirement – Protect your evenings, weekends, and personal time
• Hybrid Work Model – A blend of remote work and in-person community visits
• Paid Clinical Supervision – Support for professional growth and licensure needs
• Daily Interdisciplinary Team Meetings – Ongoing collaboration and shared clinical decision-making
• Supportive Interdisciplinary Team – Work alongside nurses, community paramedics, medical assistants, and providers
• Manageable Caseloads – Typical caseload ranges between 30–45 participants
• Mission-Driven Culture – Focused on improving lives and reducing gaps in care
• Mileage Reimbursement – Starts from the moment you leave home
• Autonomous Work Environment – Manage your day while making meaningful connections with participants

TANDEM365 is a complex medical case management and community paramedicine program that delivers innovative, patient-centered care. We support individuals with complex medical, behavioral health, and social needs by providing in-home and community-based services designed to:

• Help participants remain safely in their homes
• Reduce unnecessary emergency department visits and hospitalizations
• Improve navigation of healthcare and community resource systems

Our interdisciplinary model brings together medical social workers, nurses, community paramedics, and medical assistants to create a coordinated and seamless care experience.

At TANDEM365, we believe that when team members feel supported, trusted, and valued, they do their best work. We offer paid supervision , daily team collaboration , a self-paced orientation , and a culture that prioritizes work/life balance while allowing you to practice at the top of your license .

As a Social Work Navigator, you will provide community-based social work services to participants with complex medical and psychosocial needs. You will conduct in-home and phone assessments, develop person-centered care plans, and collaborate closely with the interdisciplinary team to support participants across the continuum of care.

• Conduct in-home and phone-based psychosocial assessments
• Identify and address social determinants of health through targeted interventions
• Coordinate care with medical providers, mental health professionals, and community agencies
• Provide resource navigation for housing, financial, food, and social supports
• Facilitate advance care planning conversations and support goal-aligned care
• Support appropriate transitions to hospice when indicated
• Empower participants through self-management education and goal setting
• Engage in challenging, goal-focused conversations with participants and families
• Partner with the interdisciplinary team to prevent unnecessary hospital utilization
• Maintain timely, accurate documentation in electronic systems

• Flexibility, resilience, and adaptability in a community-based environment
• Ability to work independently while staying connected to a collaborative team
• Strong organization and prioritization skills
• Comfort navigating multiple technologies and electronic documentation systems
• Excellent communication skills, including comfort with complex and sensitive conversations
• A collaborative, team-oriented mindset

MSW or BSW required

Active Social Work licensure in the State of Michigan (Licensed or Limited License) Required
1–2 years of social work experience required
Community-based, healthcare, post-acute, or older adult experience strongly preferred
Experience with behavioral health and complex chronic medical needs preferred
Knowledge of community resources and care coordination
Experience with Advance Care Planning, Medicare/Medicaid, or SHIP highly valued