SDoH Care Navigation Manager (Remote)

Monogram Health; United States; Remote; USD 89,000 - 116,000; Full time

Benefits offered by this job

Comprehensive Benefits

401k with employer match

20 PTO days + holidays + floating day

Wellness & growth resources

Job summary

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

Qualifications

• 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.

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.

Skills

Team leadership

Communication

Data analysis

EHR/EMR proficiency

Education

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

Master’s degree preferred

Tools

EHR/EMR software

Microsoft Office Suite

Job description

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