Job Description
Role Overview Avail Health is building a behavioral health and dementia care program supporting Medicare patients with serious mental illness, cognitive impairment, and complex psychosocial needs. The Licensed Clinical Social Worker (LCSW) / Licensed Clinical Professional Counselor (LCPC) is a fully remote clinical role that blends psychotherapy, behavioral health care management, post-discharge stabilization, dementia care integration, and caregiver support within a highly coordinated virtual care environment.
You'll work closely with the Psychiatric Mental Health Nurse Practitioner, Dementia Care Navigator, Care Coordinator, and interdisciplinary clinical leadership to support patients across longitudinal behavioral health management and post-acute transitional stabilization. Your focus is on proactive patient engagement, continuity of care, and reducing avoidable decompensation and utilization.
This is a foundational role in a newly launching program. The position ramps gradually with patient volume, with the opportunity to transition into a permanent long-term role as the Maryland behavioral health program expands.
What You'll Own • Delivery of evidence-based psychotherapy and behavioral health care management for adult and geriatric Medicare patients
• Post-discharge stabilization outreach and continuity of care for high-risk behavioral health patients
• Caregiver counseling, psychosocial assessment, and dementia care support within CMS GUIDE-aligned care models
What You'll Do • Provide evidence-based psychotherapy via telehealth to patients with SMI, depression, anxiety, trauma-related conditions, adjustment disorders, grief, and complex psychosocial needs
• Conduct proactive outreach and follow-up for high-risk patients, including post-discharge stabilization following inpatient psychiatric, medical, or post-acute admissions
• Identify and address psychosocial barriers impacting recovery, medication adherence, housing stability, caregiver support, and outpatient follow-through
• Support dementia care management activities including caregiver assessments, behavioral symptom support, psychosocial evaluations, and interdisciplinary care planning
• Participate in interdisciplinary case review and care planning discussions with the PMHNP, Dementia Care Navigator, Care Coordinator, and clinical leadership
• Escalate urgent psychiatric, behavioral, cognitive, or safety concerns appropriately to the PMHNP and care team
• Contribute frontline clinical insight to support workflow refinement, documentation standards, and scalable behavioral health infrastructure as the program grows
• Maintain timely, accurate, and compliant documentation within the EHR in accordance with organizational, payer, and regulatory requirements
What Success Looks Like • Patients with SMI, cognitive impairment, and complex psychosocial needs consistently engaged, stabilized, and supported across the care continuum
• Post-discharge behavioral health outreach completed within program timelines with strong patient engagement and continuity
• Caregiver counseling and dementia care support delivered in coordination with the interdisciplinary team, with clear documentation and care planning
• Documentation completed accurately and on time, meeting all compliance and billing requirements
• Functioning as a reliable, collaborative behavioral health member of the interdisciplinary team with responsive communication and integrated workflows
What You Bring Required: • Master's degree in Social Work, Counseling, or a related behavioral health field from an accredited program
• Active, unrestricted LCSW or LCPC licensure in the State of Maryland in good standing
• Minimum 3–5 years of post-licensure clinical experience in behavioral health assessment, psychotherapy, psychosocial stabilization, and care coordination across adult and geriatric populations
• Clinical experience with SMI, mood disorders, anxiety, trauma-related conditions, substance use disorders, cognitive impairment, and complex psychosocial needs
• Experience supporting patients with dementia and related behavioral or psychosocial concerns, including caregiver support and interdisciplinary care planning
• Experience supporting patients transitioning from inpatient psychiatric, medical, or post-acute settings to community-based care
• Proficiency with EHRs, telehealth platforms, and technology-enabled clinical workflows
• Reliable high-speed internet and a dedicated, HIPAA-compliant home workspace
Preferred: • Fluency or conversational proficiency in Spanish
• Familiarity with Medicare Advantage, TCM, longitudinal care management, or value-based care models
• Familiarity with the CMS GUIDE model or other dementia-focused care navigation programs
• Experience with ambient AI scribe tools or other technology-enabled clinical workflow platforms
• Experience working within startup healthcare organizations, new program launches, or rapidly scaling care environments
Schedule and Work Style Work Type: Fully remote - virtual telehealth delivery
Schedule: Monday–Friday, standard business hours ET
Travel: None required
Autonomy: High - functions independently as the behavioral health clinician within an interdisciplinary virtual care team
Compensation and Perks
Salary Range: $95,000–$115,000 annually, commensurate with experience.
Key Benefits:
- Medical, dental, and vision insurance; 100% employee premium coverage with DPC model
- HSA contributions | Life & disability insurance
- 401(k) with 2% employer match
- 15 days PTO (increasing with tenure) | 8 + 1 floating holidays
- Discretionary performance bonus | Annual compensation review
- All devices and ambient AI scribe tools provided
About Avail Health Avail Health is a Nurse Practitioner–founded organization delivering mobile and virtual care to Medicare-age patients. We combine technology, operational rigor, and clinical excellence to improve outcomes for complex populations. For more visit
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Job Tags
Permanent employment, Full time, Remote work, Monday to Friday