Job Summary
We are seeking a motivated, community\-driven Social Worker (MSW) to join the ICW Care Coordination team in a unique remote/field\-based capacity. This position offers the flexibility of working remotely while spending meaningful time out in the community — visiting skilled nursing facilities, assisted living facilities, primary care offices, and patient homes across the ICW service area. You will serve as a vital link between patients, their providers, and the community resources they need, building trusted relationships in the field and ensuring patients receive the right support at every step of their care journey. In this role, you will work collaboratively alongside our RN care coordination team to support our most complex, high\-utilizing patients — contributing your social work expertise to shared case discussions in our weekly Interdisciplinary Team Meeting (ITM) and partnering with the team to drive meaningful outcomes for the members we serve.
ICW Service Area: This role serves the Puget Sound corridor from Everett to Olympia, with the bulk of the caseload concentrated in the Seattle\-Tacoma metro area.
Who We Are
Independent Clinics of Washington (ICW) is an alliance of local healthcare providers dedicated to offering Medicaid and Medicare patients high\-quality, individualized care, while helping independent practices stay independent. ICW helps local providers build their practices and care for their patients by managing administrative tasks, negotiating rates with plans, cutting red tape for faster claims processing, minimizing authorization requirements, advocating for patients, connecting local providers in a supportive network, and more. Our care coordination department is a multidisciplinary team that prioritizes and recognizes the dignity and value of all people, adhering to the social work code of ethics and professional standards.
Key Responsibilities
- Conduct regular in\-person visits to skilled nursing facilities, assisted living facilities, adult family homes, hospitals, primary care offices, and patient homes to assess patient needs and coordinate care.
- Build and maintain relationships with PCP offices, facility staff, discharge planners, and community partners to support seamless patient transitions and ongoing care coordination.
- Conduct comprehensive social determinants of health assessments and connect patients with community resources including housing, food assistance, transportation, financial aid, and social support services.
- In collaboration with the ITM care team and community partners, develop care plans and implement individualized, patient\-centered care.
- Support transitions of care by conducting post\-discharge follow\-up visits and coordinating with facility staff, PCPs, and families to reduce hospital readmissions.
- Advocate for patients’ needs, rights, and preferences with facility staff, medical providers, and community agencies.
- Assist patients and families in navigating insurance, benefits enrollment, and public programs (e.g., Medicaid, Medicare, Apple Health).
- Provide urgent intervention in the field as needed, including coordination of emergent referrals.
- Complete timely, accurate documentation while managing a mobile schedule across multiple sites.
- Adhere to ICW’s policies and procedures, including compliance with HIPAA privacy and security requirements and all state, federal, and plan regulatory mandates.
- Collaborate with the RN care coordination team to identify complex and high\-utilizing patients, contribute social work expertise to weekly Interdisciplinary Team Meeting (ITM) discussions, and support shared follow\-up and case resolution.
- Other duties as assigned.
- Excellent verbal and written communication skills; ability to build rapport quickly across diverse settings
- Cultural humility and awareness; experience working with diverse, underserved, and complex patient populations
- Strong self\-direction and ability to manage an independent schedule across multiple field locations
- Understanding of trauma\-informed and patient\-centered care models and interventions
- Familiarity with skilled nursing facilities, assisted living settings, and PCP office workflows
- Broad knowledge of Washington State community resources, social service agencies, and public benefit programs
- Problem\-solving aptitude and composure when navigating challenging situations independently in the field
- Computer skills including Microsoft Office Suite, Zoom, Adobe, etc.
- Master’s degree in Social Work (MSW) from a CSWE\-accredited program
- Minimum two (2\) years of post\-graduate social work experience, preferably in community\-based, inpatient hospital, long\-term care, or field\-based settings
- Valid Washington State Driver’s License, reliable personal vehicle, and current auto insurance required — this position involves regular travel throughout the service area
- Prior experience working in skilled nursing facilities, assisted living, adult family homes, or community health settings
- Experience in inpatient hospital case management, including discharge planning, care transitions, and working alongside hospital clinical teams
- Bilingual or multilingual (Spanish, Somali, Vietnamese, or other languages reflecting our patient population)
- Certification in case management (CCM or ACM)
- Competitive salary and comprehensive benefit package
- Remote position with the variety and connection of field\-based community work — the best of both worlds
- Opportunities for professional growth and continuing education support
- Flexible scheduling to support work\-life balance
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
- This position requires regular travel throughout the Puget Sound corridor from Everett to Olympia, with the majority of work concentrated in the Seattle\-Tacoma metro area. Do you reside within or near this service area and do you have a valid Washington State Driver's License, reliable personal vehicle, and current auto insurance to support this travel requirement?
- Do you have a minimum of two (2\) years of post\-graduate social work experience in a community\-based, hospital, long\-term care, or field\-based setting?
- Do you have experience participating in and contributing to interdisciplinary or multidisciplinary team meetings (e.g., care conferences, team rounds, or case review meetings) in a collaborative team setting? If yes, please describe.
Required Knowledge, Skills, and Abilities
Basic Qualifications
Preferred Qualifications
As part of the ICW team, you will receive:
Equipment Requirements
Employees are required to use their own computer monitors and headset; a company\-provided laptop will be issued.
*Note*
The statements herein are intended to describe the general nature and level of work being performed by employees in this position and are not to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.
Pay: $33\.65 \- $40\.87 per hour
Benefits:
Application Question(s):
Work Location: Hybrid remote in SeaTac, WA 98188