Social Worker- Pilot CCM

ROMTech; Brookfield (CT); On-site; USD 55,000 - 75,000; Full time

Job summary

ROMTech, a medical technology company, seeks a Contract Social Worker to support the Chronic Care Management program. You will perform psychosocial assessments, coordinate care, and connect patients with housing, transportation, and financial resources, ensuring CMS CCM guidelines are followed.

Based in Florida, you will collaborate with interdisciplinary teams, document in EHR/ CCM platforms, and provide education to improve adherence and outcomes for patients with chronic conditions.

Qualifications

• Requires Florida Social Work license (active).
• MSW strongly preferred; BSW/ MSW acceptable with experience.
• Experience in care management, population health, or chronic disease management helpful.

Responsibilities

• Conduct psychosocial assessments to identify patient needs, barriers to care, and social determinants of health.
• Coordinate with interdisciplinary teams to develop and execute individualized care plans.
• Provide short-term supportive counseling and education to patients managing chronic conditions.
• Identify and connect patients with community resources (housing, transportation, food assistance, behavioral health, financial services).
• Support adherence to care plans and medications through structured follow-up and coaching.
• Assist with care transitions, including post-discharge coordination and patient support.
• Maintain compliant documentation in EHR/ CCM platforms and participate in care consultations.

Skills

Care coordination

Psychosocial assessments

Interdisciplinary collaboration

Documentation

Verbal communication

Education

MSW preferred

Bachelor’s or Master’s in Social Work

Tools

EHR systems

Telehealth platforms

Job description

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.Job PurposeThe Contract Social Worker supports the Chronic Care Management (CCM) program by providing psychosocial assessments, care coordination, and resource navigation for patients with chronic and complex conditions. This role contributes to improved patient outcomes, adherence to care plans, and reduced barriers to care by addressing social determinants of health and connecting patients with appropriate services. The position supports interdisciplinary collaboration and ensures alignment with CMS CCM guidelines and organizational care delivery objectives. This position is based out of Florida. An Active Florida Social Work License is required.Key ResponsibilitiesEssential DutiesConduct psychosocial assessments to identify patient needs, barriers to care, and social determinants of healthCollaborate with interdisciplinary care teams to support development and execution of individualized care plansProvide short-term supportive counseling and emotional support to patients managing chronic conditionsIdentify and facilitate access to community-based resources including housing, transportation, food assistance, behavioral health, and financial servicesSupport patient adherence to care plans and medication regimens through education and structured follow-upAssist with care transitions, including post-discharge coordination and patient supportMaintain accurate, timely, and compliant documentation in EHR and CCM platformsParticipate in case consultations or interdisciplinary discussions as needed to support patient outcomesEnsure all activities align with HIPAA and CMS Chronic Care Management guidelinesOther FunctionsParticipate in program improvement initiatives or workflow optimization efforts as mutually agreedSupport onboarding or knowledge-sharing activities related to CCM services if applicablePerforms other mutually agreed upon duties consistent with the applicable engagement or contractJOB QUALIFICATIONSSkills and AbilitiesRequired:This position is based out of Florida. An Active Florida Social Work License is required.Strong understanding of social determinants of health and care coordination principlesExcellent communication and interpersonal skills for patient engagementAbility to work independently and manage caseloads in a structured, outcome-focused mannerStrong organizational and documentation skillsAbility to navigate community-based resources effectivelyPreferred:Experience in chronic care management or population health programsFamiliarity with telehealth platforms and EHR systemsBilingual (English/Spanish)Work Experience RequirementsRequired:2–3 years of experience in care management, medical social work, or chronic disease managementPreferred:Experience working with Medicare or high-risk patient populationsBackground in behavioral health, geriatrics, or case managementEducation RequirementsRequired:Bachelor’s or Master’s degree in Social Work (MSW strongly preferred)License and Certification RequirementsRequired:Active Florida Social Work License (externally required for practice — assumed)LCSW preferredPhysical Demands and Working ConditionsThe following describes the physical demands and work environment characteristics required to perform the essential functions of this position. These requirements are representative of those an employee may encounter while performing the job and are not intended to be an exhaustive list. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the role.Ability to sit at a computer terminal for an extended period.Moderate noise (i.e., phone calls, online meetings, computer audio)While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.Specific vision abilities required by this job include close vision requirements due to computer work.Regular, predictable attendance is required.Must be able to communicate clearly and professionally in both verbal and written formats.Must be able to engage in active listening and express ideas effectively in person, by phone, and via virtual meetings.The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Reasonable accommodation requests must be made in writing by emailing [e-mail].