High-Risk Care Coordinator Social Worker (Hybrid)

Conviva Senior Primary Care; Fort Lauderdale (FL); Hybrid; USD 65,000 - 89,000; Full time

Job summary

Conviva Senior Primary Care is seeking a Social Worker for its High‑Risk Patient Management program. You’ll assess psychosocial needs, coordinate care, and intervene to overcome barriers affecting engagement and safe transitions across settings.

working in a hybrid setup near designated clinics, you will be onsite 2–3 days per week with remaining days from home. A master’s in social work and state licensure eligibility are required, with 3+ years of relevant experience in complex care

Qualifications

• MSW degree from an accredited program.
• Licensure: Licensed or license-eligible per state requirements (LCSW welcome but not required).
• Minimum 3 years of clinical social work experience with complex care and case coordination.
• Experience with high-risk medically complex or socially vulnerable populations.

Responsibilities

• Provide psychosocial assessment and care coordination for high-risk patients.
• Deliver time-limited, outcomes-focused social work interventions.
• Coordinate with Care Coach and PCP to address socioeconomic barriers and psychosocial needs.
• Identify barriers and facilitate connections to community social, housing, and behavioral health resources.
• Support referrals, documentation, and follow-up per regulatory standards.
• Partner with Care Coach to ensure continuity of care and reduce readmissions.

Skills

Psychosocial assessment

Care coordination

Engagement & communication

Cultural humility

Independent work

Education

Master’s degree in Social Work (MSW)

Social work licensure (state-licensure required/eligible)

Job description

Conviva Senior Primary Care is seeking a Social Worker for its High‑Risk Patient Management program. You’ll assess psychosocial needs, coordinate care, and intervene to overcome barriers affecting engagement and safe transitions across settings.

working in a hybrid setup near designated clinics, you will be onsite 2–3 days per week with remaining days from home. A master’s in social work and state licensure eligibility are required, with 3+ years of relevant experience in complex care