Palliative & Community Social Worker

Devoted Health

Houston, TX, USA

Full time

Oct 28

This job is no longer accepting applications.

This specific role includes providing support to our palliative care team as a community case manager as well as a Community Case Manager for Devoted’s comprehensive care teams.


As a Community Case Manager for the comprehensive care teams, you will serve our members as an advocate - working with members and their caregivers to identify and reduce non-clinical barriers to care. You will develop personalized plans to get members the care they need to sustain a certain quality of life and support them to achieve this plan. You will learn a lot about the community environment and how it supports (or doesn’t support) the members’ needs. Based on your local expertise, you will use social services and community programs to support our members in the best way possible. 


Devoted’s virtual Palliative Care program serves members with complex needs and life-limiting illness who otherwise would not have access to specialized palliative care. We pride ourselves on providing highly compassionate, patient-centered goals of care counseling and symptom management for members projected to be in the final year of life. We meet patients where they are and support them in defining quality of life, achieving meaningful goals, and transitioning to hospice care.  

Responsibilities will include:

  • Establish trust and build strong relationships with our members 
  • Create personalized care plans for members tailored to members’ needs 
  • Identify and catalog available community or national resources (i.e., transportation, financial, food, medication discounts, support groups) 
  • Connect members to community services and follow up to ensure those services were received 
  • Help members (especially low income members) get the resources/care they need by helping them apply for eligible government benefits and programs 
  • Work with family members/caregivers to help them in understanding the member’s needs and how they can be supportive 
  • Conduct home visits or calls to members (infrequent, but within job expectations)
  • Coordinate with other Devoted services, such a Devoted Medical Group or benefits offered via the Health Plan
  • Form strong relationships with local PCP offices and aid with coordination between member, Devoted, PCP’s office, specialist office, hospital 

Responsibilities specific to palliative care:

  • Lead goals of care discussions with palliative patients 
  • Provide psychosocial assessment and follow up with palliative patients: monthly for higher acuity patients, as needed for lower acuity patients
  • Manage or lead conversations with patients, caregivers, and family regarding goals of care, and social drivers of advanced care planning
  • Assist with advanced care planning for palliative patients 
  • Participate in weekly palliative team rounds
  • Interdisciplinary collaboration with other members of team to ensure patient-centric palliative care

Attributes to success:

  • You’re a caring problem solver who can break down barriers 
  • You connect with people quickly 
  • You follow up relentlessly 
  • A deep caring to make a change in the healthcare experience: you love to serve and make a difference 
  • The ability to adjust your tone and approach to different people 
  • You can articulate and break down complex information 
  • Being present, reliable and timely - for our members, for your team 
  • The ability to work in a startup environment: which means moving quickly and being transparent in your work, what’s going well, what’s not 
  • You enjoy a fast-paced, high-energy, organization.
  • Agility and collaboration are key as we will change and improve quickly. 
  • You are comfortable engaging and learning new technologies including electronic health records, operating systems and programs (Google Office, Slack).
  • You thrive on knowing your work can help make these technologies better for you and your patients.
  • You learn from every experience and are not afraid to fail - that's how you're wired.
  • Finally and most importantly, you have a passion for making healthcare better for patients at end-of-life, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Desired skills and experience; Must-Haves:

  • Master’s degree in social work
  • A minimum of 3 years doing case management or care coordination 
  • Minimum of 2 years expertise in palliative or hospice with proficiency in leading goals of care conversations, assisting with advanced care planning, and supporting people through grief, loss, and bereavement
  • Certified hospice and palliative social work credential, or willingness to obtain within one year of employment
  • Comfortable with technology and a fast-paced environment
  • Self-starter with ability to succeed in a work-from-home environment 
  • Strong interpersonal and communication skills

Desired skills and experience; Nice-to-Haves:

  • Bilingual in English and Creole, Spanish, or Vietnamese.
  • Experience in health insurance (Medicare Advantage a plus) 
  • Experience in geriatrics 
  • Licensed Social Worker credential

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.


#LI-SS1


If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.


Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.


As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.


COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance.




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