Care Coordinator, LSW (MSHO)

Bluestone

Rogers (MN)

Hybrid

USD 65,000 - 75,000

Full time

14 days+

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Benefits offered by this job

Health Insurance

Dental Insurance

Vision Materials Insurance

Company paid Life Insurance

Short and Long-term Disability

Health Savings Account (with employer)

Job summary

Bluestone is seeking a Care Coordinator to empower Minnesota seniors to navigate their healthcare journey. You will handle DHS and CMS requirements for MSHO/MSC+ members, traveling locally and working from home part-time.

The role is hybrid (home and field visits) with 65k–75k USD salary, and a strong emphasis on teamwork, quality care, and community resources in Minnesota, Wisconsin and Florida.

Qualifications

Current MN Licensed Social Worker required; new grads welcome.
Optionally MN RN license; relevant case management experience preferred.
Valid driver's license is required.

Responsibilities

Coordinate face-to-face visits within assigned geographic area.
Manage Elderly Waiver and PCA assessments for residents.
Develop individualized care plans based on health needs.
Connect members with community resources and services.
Support safe aging in place and transitions of care.
Complete required documentation accurately.
Collaborate with medical teams to meet quality measures.
Assist with safe discharges and follow-up planning.

Skills

Independent work

Private home office

Creative problem solving

Diversity engagement

Verbal communication

Interpersonal skills

English language proficiency

Education

MN Licensed Social Worker (LSW/LMSW/LISW/LICSW)

Minnesota Registered Nurse license

Job description

Bluestone delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs.

Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients' chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period.

Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida.

Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day.

Bluestone has been named to the Star Tribune's Top Workplace list for the 14th year in a row! Bluestone also achieved Top Workplace USA 2021-2026! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

Position Overview

Join our team as a Care Coordinator, empowering Minnesota's senior population to navigate their healthcare journey and live healthier, more independent lives. In this role, you'll manage Department of Human Services (DHS) and Center for Medicare/Medicaid Services (CMS) requirements for MSHO/MSC+ members. This is a hybrid position where you'll work from home while traveling locally to meet directly with members in their homes and assisted living facilities, helping them access vital medical care, waiver services, and community resources.

Schedule

Full-time, 8:00 AM – 5:00 PM (Monday through Thursday) and 8:00 AM – 3:00 PM (Friday). No evenings, weekends, holidays, or on-call requirements.

Location

Hybrid — Rogers, Minnesota area (50–70% local community visits; 30–50% remote work from home)

Salary Range

$65,000 - $75,000, commensurate with experience.

Responsibilities

As a Care Coordinator, you will manage member caseloads within your assigned geographic area. Key responsibilities include:

Coordinating face-to-face visits
Managing the Elderly Waiver
Conducting annual assessments including Personal Care Assistance (PCA) assessments for community members and customized living tools for members residing in Assisted Livings
Reviewing current health needs, identifying goals, and developing individualized care plans
Helping connect members with community and state resources and services
Help members remain safely in their homes and communities
Completing required documentation
Collaborating with medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goals
Supporting members during transitions of care as well as collaborating with their care team to ensure a safe discharge and follow up plan

Additional Benefits of Joining Bluestone's Care Coordination Team

Comprehensive 6-month onboarding program
Dedicated preceptor support
Ongoing mentoring and coaching
Continuing education and professional development
Collaborative managers who work alongside you
Experienced documentation auditors focused on education and quality

Qualifications

Education/Certification/Experience

Current MN Licensed Social Worker (LSW, LMSW, LISW, or LICSW) - New grads encouraged to apply!
OR Minnesota Registered Nurse license
One or more years of experience working with the geriatric or certified disabled population in case management/care coordination, Home Care, Group Homes, Nursing Homes, TCU or Assisted Living settings preferred
Must have a valid driver's license

Knowledge/Skills/Abilities