This Part-time Outpatient Case Management role is responsible for coordinating patient services, addressing social determinants of health, and connecting individuals to appropriate resources. As a rehabilitation hospital network, our goal is to promote independence, optimize functional outcomes, and reduce barriers to accessing necessary services and supports in the community.
Key responsibilities include: * Coordinate Care Across Settings: Coordinate care across outpatient specialties and services.
* Equipment and Home Support Services
Facilitate access to durable medical equipment (DME), home health services, personal care assistants, and assistive technologies necessary for outpatient functioning.
* Connect Patients to Resources: Identify patient needs related to housing, transportation, food insecurity, financial assistance, and other social determinants of health. Facilitate access to community resources and social service programs.
* Perform Comprehensive Assessments: Conduct psychosocial and needs assessments to evaluate barriers to care, support systems, and community resource eligibility.
* Social Services Navigation: Assist patients in applying for public assistance programs (e.g., Medicaid, SNAP, housing subsidies), and liaise with local agencies, and nonprofit organizations.
* Community Resource Navigation
Connect patients to community-based programs including vocational rehabilitation, independent living centers, transportation services, peer support groups, and long-term services and supports (LTSS).
* Advocate for Patient Needs: Act as a liaison between patients, providers, insurers, and external organizations to ensure appropriate and timely services.
* Follow-Up and Monitoring: Provide ongoing support to prevent avoidable emergency room visits and hospitalizations.
* Addressing Social Determinants of Health
Screen for and address barriers such as housing instability, food insecurity, financial hardship, caregiver burden, and access to care. Assist with applications for benefits such as SSI/SSDI, Medicaid waivers, and home modification grants.
* Documentation and Compliance: Maintain accurate, timely documentation in electronic health records (EHRs), ensuring compliance with HIPAA and organizational policies. Education
Master's Degree Social Work required or
Master's Degree Related Field of Study preferred or
Master's Degree Mental Health required
Can this role accept experience in lieu of a degree? No
Licenses and Credentials
Social Worker, Licensed Clinical [LCSW - State License] preferred
Social Worker, Licensed Independent Clinical [LICSW - State License] preferred
Occupational Therapist [State License] preferred
Physical Therapist [State License] preferred
Certified Rehabilitation Counselor [CRC] preferred
Licensed Mental Health Counselor [State License] preferred
Licensed Rehabilitation Counselor [Massachusetts] preferred
Respiratory Therapist [Massachusetts] preferred Experience:
Minimum 2-3 years of experience in case management, care coordination, or discharge planning. Experience working with patients with disabilities, in outpatient or ambulatory care settings. Familiarity with community-based programs, durable medical equipment (DME), and home and community-based services (HCBS).
Knowledge, Skills & Abilities
Care Coordination
Proven ability to develop, implement, and monitor individualized care plans, and to coordinate across disciplines and settings. Patient Advocacy
Strong advocacy skills to ensure that patients receive necessary supports, resources, and accommodations. Resource Navigation
Skilled in connecting patients and families to community-based resources, benefits programs, and support services (e.g., Medicaid waivers, vocational rehab, transportation). Communication Skills
Excellent verbal and written communication skills with the ability to interact effectively with patients, caregivers, providers, and community partners. Ability to maintain client and staff confidentiality. Problem Solving and Critical Thinking
Ability to assess complex situations and implement patient-centered solutions quickly and effectively. Documentation and Technology Proficiency
Proficient in Microsoft Office and industry related software programs. Cultural Competency
Demonstrated ability to provide culturally sensitive care and work effectively with diverse populations. Teamwork and Collaboration
Experience working in interdisciplinary teams and collaborating across departments or agencies.
Physical Requirements
Standing Frequently (34-66%)
Walking Frequently (34-66%)
Sitting Occasionally (3-33%)
Lifting Frequently (34-66%) 35lbs+ (w/assisted device)
Carrying Frequently (34-66%) 20lbs - 35lbs
Pushing Occasionally (3-33%)
Pulling Occasionally (3-33%)
Climbing Rarely (Less than 2%)
Balancing Frequently (34-66%)
Stooping Occasionally (3-33%)
Kneeling Occasionally (3-33%)
Crouching Occasionally (3-33%)
Crawling Rarely (Less than 2%)
Reaching Frequently (34-66%)
Gross Manipulation (Handling) Frequently (34-66%)
Fine Manipulation (Fingering) Frequently (34-66%)
Feeling Constantly (67-100%)
Foot Use Rarely (Less than 2%)
Vision - Far Constantly (67-100%)
Vision - Near Constantly (67-100%)
Talking Constantly (67-100%)
Hearing Constantly (67-100%)
The Spaulding Rehabilitation Hospital Corporation is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Spaulding Hospital - Boston and Cambridge
Aug 20, 2025