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Salary: USD 65,000 - 75,000 / annual
Bluestone Physician Services is seeking a Care Coordinator with a Licensed Social Worker (LSW) credential to join their multidisciplinary care team serving seniors and disabled populations across Minnesota, Wisconsin, and Florida. The company specializes in managing complex, chronic conditions through evidence-based care coordination, achieving measurable outcomes including 21% fewer ER visits, 36% fewer hospitalizations, and 41% fewer hospital readmissions compared to similar patient populations.
In this hybrid role based in the St. Paul/Roseville area, you will manage member caseloads within an assigned geographic area, spending 50–70% of time conducting face-to-face visits in members' homes and assisted living facilities, and 30–50% working remotely. You'll coordinate care for MSHO/MSC+ members under Department of Human Services (DHS) and Centers for Medicare & Medicaid Services (CMS) requirements.
Key responsibilities include: coordinating face-to-face visits; managing the Elderly Waiver program; conducting annual assessments including Personal Care Assistance (PCA) evaluations; reviewing health needs and developing individualized care plans; connecting members with community and state resources; helping members remain safely in their homes; completing required documentation; collaborating with medical care teams to meet health care quality measures and value-based goals; and supporting members during care transitions with safe discharge and follow-up planning.
The position offers a structured onboarding program with a dedicated preceptor, ongoing mentoring and coaching, continuing education support, and collaborative management. Schedule is full-time: Monday–Thursday 8:00 AM–5:00 PM, Friday 8:00 AM–3:00 PM, with no evenings, weekends, holidays, or on-call requirements. Benefits include comprehensive health insurance (medical, dental, vision), company-paid life insurance, short/long-term disability, HSA with employer contribution, FSA, 401(k) with 4% matching, 9 paid holidays plus 1 floating holiday, 15 days PTO, mileage reimbursement, and company-provided cell phone, laptop, and scrubs.
**Requirements:**
- Current Minnesota Licensed Social Worker (LSW, LMSW, LISW, or LICSW) credential required; new graduates encouraged to apply. Alternatively, Minnesota Registered Nurse license acceptable.
- One or more years of experience working with geriatric or certified disabled populations in case management, care coordination, home care, group homes, nursing homes, transitional care units, or assisted living settings preferred.
- Valid driver's license required.
- Ability to work independently with access to a private, compliant home office space.
- Strong verbal and written communication skills; excellent interpersonal and customer service abilities.
- Creative problem-solving skills and demonstrated appreciation for working with diverse populations.
- Demonstrated ability to read, write, speak, and understand English.
- Compatibility with Bluestone's mission and operating philosophies.
