Social Work Navigator

Job DescriptionJob DescriptionSocial Work Navigator (MSW/BSW) – Community-BasedMake 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 visitsSupportive Interdisciplinary Team – Collaborate with nurses, community paramedics, medical assistants, and providersMission-Driven Culture – Focused on improving lives and reducing gaps in careMileage Reimbursement – Starts from the moment you leave homeAutonomous Work Environment – Manage your day while making meaningful connections with participantsWho We AreTANDEM365 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 homesReduce unnecessary emergency department visits and hospitalizationsImprove navigation of the healthcare and community resource systemsOur 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 HereAt 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 NavigatorAs 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.Key Responsibilities:Conduct in-home and phone-based psychosocial assessments to inform individualized plans of careIdentify and address social determinants of health through targeted interventionsCoordinate and collaborate with mental health providers, medical providers, and community agenciesProvide resource connection and navigation, including housing, financial, food, and social supportsFacilitate advance care planning conversations and support goal-aligned careSupport appropriate transitions to hospice when indicatedEmpower participants through self-management education and goal settingConduct challenging, goal-focused conversations with participants and familiesPartner with the interdisciplinary team to prevent unnecessary hospital utilizationMaintain timely and accurate documentation using electronic systemsWhat You’ll Need to SucceedFlexibility, resilience, and adaptability in a fast-paced, community-based environmentAbility to work independently and autonomously while staying connected to a teamStrong organizational and prioritization skillsComfort navigating multiple technologies and electronic documentation systemsExcellent communication skills, including comfort with complex and sensitive conversationsA collaborative, team-oriented mindsetEducation & Experience RequirementsMaster of Social Work (MSW) preferred/ Experienced BSW considered Active Social Work licensure in the State of MichiganMinimum of 3 years of social work experienceExperience in community-based, healthcare, post-acute, or older adult care strongly preferredExperience supporting individuals with behavioral health conditions and complex chronic medical needs preferredKnowledge of community resources and strong care coordination skillsExperience with Advance Care Planning, Medicare/Medicaid, or SHIP is highly valuedReady 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.