Care Transitions & Case Management Coordinator

Cape Fear Valley Health; Fayetteville (NC); Hybride; USD 55 000 - 73 000; Plein temps

Résumé du poste

Cape Fear Valley Health seeks a SW Transitions and Care Coordinator in Fayetteville, NC to manage CAP case management, care planning, referrals and follow-up. The role focuses on community transitions, reducing readmissions and coordinating with interdisciplinary teams.

The ideal candidate has an MSW, state licensure or CCM preferred, strong communication and organizational skills, and the ability to work independently on a day shift. Travel for home visits may be required.

Qualifications

• Master’s degree in Social Work (MSW) required.
• National Certification in Case Management or LCSW preferred.
• Maintain state requirements for CAP transitions or case management.

Responsabilités

• Provides case management and care coordination to assigned caseload.
• Coordinates Money Follows the Person and Community Transitions to reduce hospital stays.
• Performs comprehensive interdisciplinary needs assessments monthly.
• Develops and documents the plan of care with person‑centered goals.
• Provides follow‑up visits post-discharge to reduce readmissions.

Connaissances

English proficiency

Communication skills

Problem solving

Organizational skills

Independent work

Formation

MSW degree

Licensure / CCM preferred

State requirements knowledge

Description du poste

Cape Fear Valley Health seeks a SW Transitions and Care Coordinator in Fayetteville, NC to manage CAP case management, care planning, referrals and follow-up. The role focuses on community transitions, reducing readmissions and coordinating with interdisciplinary teams.

The ideal candidate has an MSW, state licensure or CCM preferred, strong communication and organizational skills, and the ability to work independently on a day shift. Travel for home visits may be required.