Manager SDOH

Monogram Health; United States; Remoto; USD 89.000 - 116.000; Tempo pieno

Vantaggi offerti da questo lavoro

Comprehensive Benefits

401k with employer match

20 PTO days + holidays + floating day

Wellness & growth resources

Descrizione del lavoro

Monogram Health is seeking a Manager of Social Determinants of Health to lead care navigation and social care initiatives, overseeing a team of Care Navigators to identify social barriers and connect patients with community resources. You will support care plan goals and measure outcomes related to engagement and equity.

The role emphasizes program performance, workflow optimization, and culturally responsive, person-centered support across diverse populations within a care model focused on

Competenze

• Bachelor’s degree in Social Work, Healthcare Administration, Public Health, or related field. Master’s degree preferred.
• Minimum of three years in social services, care management, population health, or healthcare operations.
• Experience managing teams and driving operational performance to improve engagement and outcomes.
• Proficient in EHR/EMR software and data analysis.

Mansioni

• Directly manage, coach, and develop a team of Care Navigators.
• Establish productivity, quality, engagement, and documentation expectations for Care Navigators.
• Conduct regular performance reviews, audits, coaching sessions, and career development planning.
• Monitor navigator caseloads and resource allocation to ensure timely patient outreach and follow-up.
• Ensure consistent execution of Care Navigator workflows, policies, and best practices.
• Serve as an escalation point for complex patient needs, resource barriers, and challenging social situations.
• Partner with Talent Acquisition and Operations leaders to support hiring, onboarding, and workforce planning.
• Oversee Care Navigator activities related to outreach, engagement, education, and resource coordination.
• Ensure accurate screening and documentation of social determinants of health needs.
• Monitor completion of referrals and follow-up activities to improve successful resource connections.
• Develop processes that increase patient participation and reduce barriers to engagement.
• Ensure patients receive culturally responsive, person-centered support that aligns with Monogram's care model.
• Evaluate navigator effectiveness through patient outcomes, engagement rates, and quality metrics.
• Lead organizational efforts to identify and address social barriers impacting health outcomes.
• Monitor SDoH screening, referral management, and closed-loop referral processes.
• Analyze trends across social needs categories, including, food insecurity, housing instability, transportation barriers, financial hardship, utility assistance, social isolation, access to healthcare services, and health literacy.
• Develop strategies to improve resource utilization and social needs resolution.
• Collaborate with market and clinical leadership on health equity initiatives.

Conoscenze

Team leadership

Communication

Data analysis

EHR/EMR proficiency

Formazione

Bachelor’s degree in Social Work, Healthcare Administration, Public Health, or related field

Master’s degree preferred

Strumenti

EHR/EMR software

Microsoft Office Suite

Descrizione del lavoro

Position: Manager, Social Determinants of Health

The Manager, Social Determinants of Health (SDoH) leads Monogram Health's Care Navigation function and Social Determinants of Health initiatives. This role is responsible for managing a team of Care Navigators who engage patients, identify social barriers to care, facilitate community resource connections, and support overall care plan goals.

The Manager ensures the Care Navigation team delivers high-quality, timely, and patient-centered support while driving program performance, process improvement, and outcomes related to patient engagement, social needs resolution, and health equity. This leader serves as the primary subject matter expert for social care integration and collaborates closely with operational leaders and the pod care team including Advanced Practice Practitioners, Registered Nurses, and Behavioral Health Clinicians (LCSWs) to ensure comprehensive whole-person care. This position may be located in Brentwood, TN or remote with domestic travel up to 20%.

Responsibilities

• Directly manage, coach, and develop a team of Care Navigators.
• Establish productivity, quality, engagement, and documentation expectations for Care Navigators.
• Conduct regular performance reviews, audits, coaching sessions, and career development planning.
• Monitor navigator caseloads and resource allocation to ensure timely patient outreach and follow-up.
• Ensure consistent execution of Care Navigator workflows, policies, and best practices.
• Serve as an escalation point for complex patient needs, resource barriers, and challenging social situations.
• Partner with Talent Acquisition and Operations leaders to support hiring, onboarding, and workforce planning.
• Oversee Care Navigator activities related to outreach, engagement, education, and resource coordination.
• Ensure accurate screening and documentation of social determinants of health needs.
• Monitor completion of referrals and follow-up activities to improve successful resource connections.
• Develop processes that increase patient participation and reduce barriers to engagement.
• Ensure patients receive culturally responsive, person-centered support that aligns with Monogram's care model.
• Evaluate navigator effectiveness through patient outcomes, engagement rates, and quality metrics.
• Lead organizational efforts to identify and address social barriers impacting health outcomes.
• Monitor SDoH screening, referral management, and closed-loop referral processes.
• Analyze trends across social needs categories, including, food insecurity, housing instability, transportation barriers, financial hardship, utility assistance, social isolation, access to healthcare services, and health literacy.
• Develop strategies to improve resource utilization and social needs resolution.
• Collaborate with market and clinical leadership on health equity initiatives.

Position Requirements

• Bachelor’s degree in Social Work, Healthcare Administration, Public Health, or related field. Master’s degree preferred
• Minimum of three (3) years of experience in social services, care management, population health, healthcare operations
• Experience managing teams and driving operational performance to improve team performance, patient engagement, and patient outcomes.
• Demonstrated communication and relationship building skills.
• Comfort working with diverse populations and complex social needs.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficient in EHR/EMR software, Microsoft Office Suite, and data analysis
• Experience working with Medicaid, Medicare, or value-based care populations is preferred.

Compensation

The base salary range for this role is $88,880 to $115,544 and reflects the range of experience and qualifications we may consider. Final compensation will be determined based on geographic location and job-related factors such as experience, skills, education, certifications, and internal compensation considerations. While a larger range is posted, most offers will typically fall within a narrower band based on these factors.

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support– Competitive compensation, 401k with employer match, and financial wellness resources
• Time Off & Leave– 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave
• Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts

About Monogram Health

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.