Social Worker- Pilot CCM

ROMTech is a medical technology company that has created and patented a revolutionary medical device and telemedical platform which delivers in-home rehabilitative care. Our disruptive technology has proven to yield faster recoveries and better outcomes with unmatched patient compliance. We began in orthopedics and have entered scale-up of our orthopedic business. We are now leveraging our core technology, infrastructure, and first mover position to enter cardiology, followed by other adjacent markets. Having created this new lane, we have a unique opportunity to serve as the global leader in the business, technology, and science of recovery, and to bring life-changing help to many millions of people.

Job Purpose

The Contract Social Worker supports the Chronic Care Management (CCM) program by providing psychosocial assessments, care coordination, and resource navigation for patients with chronic and complex conditions. This role contributes to improved patient outcomes, adherence to care plans, and reduced barriers to care by addressing social determinants of health and connecting patients with appropriate services. The position supports interdisciplinary collaboration and ensures alignment with CMS CCM guidelines and organizational care delivery objectives.

Key Responsibilities Essential Duties

• Conduct psychosocial assessments to identify patient needs, barriers to care, and social determinants of health
• Collaborate with interdisciplinary care teams to support development and execution of individualized care plans
• Provide short-term supportive counseling and emotional support to patients managing chronic conditions
• Identify and facilitate access to community-based resources including housing, transportation, food assistance, behavioral health, and financial services
• Support patient adherence to care plans and medication regimens through education and structured follow-up
• Assist with care transitions, including post-discharge coordination and patient support
• Maintain accurate, timely, and compliant documentation in EHR and CCM platforms
• Participate in case consultations or interdisciplinary discussions as needed to support patient outcomes
• Ensure all activities align with HIPAA and CMS Chronic Care Management guidelines
  
  

Other Functions

• Participate in program improvement initiatives or workflow optimization efforts as mutually agreed
• Support onboarding or knowledge-sharing activities related to CCM services if applicable
• Performs other mutually agreed upon duties consistent with the applicable engagement or contract