Social Work Navigator

Job Description

Job Description

Social Work Navigator (MSW/BSW) – Community-Based Make a Difference with TANDEM365!

Are you a licensed Social Worker looking for a meaningful role that offers autonomy, flexibility, and the opportunity to make a real impact in your community? TANDEM365 is seeking a Social Work Navigator (MSW) to serve the Grand Rapids / Kent County area as part of our innovative, community-based care model.

Why Choose TANDEM365?

• Hybrid Work Model – A blend of remote work and in-person community visits
• Supportive Interdisciplinary Team – Collaborate with nurses, community paramedics, medical assistants, and providers
• Mission-Driven Culture – Focused on improving lives and reducing gaps in care
• Mileage Reimbursement – Starts from the moment you leave home
• Autonomous Work Environment – Manage your day while making meaningful connections with participants

Who We Are

TANDEM365 is a complex medical case management and community paramedicine program that delivers innovative, patient-centered care. We support individuals with complex medical, behavioral health, and social needs by providing in-home and community-based services designed to:

• Help participants remain safely in their homes
• Reduce unnecessary emergency department visits and hospitalizations
• Improve navigation of the healthcare and community resource systems

Our interdisciplinary model brings together medical social workers, nurses, community paramedics, and medical assistants to create a coordinated and seamless care experience.

What It’s Like to Work Here

At TANDEM365, we believe that when team members feel supported, trusted, and valued , they do their best work. We offer a self-paced orientation , strong team collaboration, and a culture that prioritizes work/life balance while allowing you to practice at the top of your license.

What You’ll Do as a Social Work Navigator

As a Social Work Navigator , you will provide community-based social work services to participants with complex medical and psychosocial needs. You will conduct in-home and phone assessments, develop person-centered care plans, and work collaboratively with the care team to support participants across the continuum of care.

• Conduct in-home and phone-based psychosocial assessments to inform individualized plans of care
• Identify and address social determinants of health through targeted interventions
• Coordinate and collaborate with mental health providers, medical providers, and community agencies
• Provide resource connection and navigation , including housing, financial, food, and social supports
• Facilitate advance care planning conversations and support goal-aligned care
• Support appropriate transitions to hospice when indicated
• Empower participants through self-management education and goal setting
• Conduct challenging, goal-focused conversations with participants and families
• Partner with the interdisciplinary team to prevent unnecessary hospital utilization
• Maintain timely and accurate documentation using electronic systems

What You’ll Need to Succeed

• Flexibility, resilience, and adaptability in a fast-paced, community-based environment

• Ability to work independently and autonomously while staying connected to a team
• Strong organizational and prioritization skills
• Comfort navigating multiple technologies and electronic documentation systems
• Excellent communication skills , including comfort with complex and sensitive conversations
• A collaborative, team-oriented mindset

Education & Experience Requirements

• Master of Social Work (MSW) preferred/ Experienced BSW considered
• Active Social Work licensure in the State of Michigan
• Minimum of 3 years of social work experience
• Experience in community-based, healthcare, post-acute, or older adult care strongly preferred
• Experience supporting individuals with behavioral health conditions and complex chronic medical needs preferred
• Knowledge of community resources and strong care coordination skills
• Experience with Advance Care Planning, Medicare/Medicaid, or SHIP is highly valued

Ready to Make an Impact? Apply Today!

Join TANDEM365 and be part of a team that is redefining community-based care and improving the lives of individuals throughout the Grand Rapids area.

Apply today to learn more about this exciting opportunity.