The Care Coordination Social Worker (CC SW) is responsible for assessing transitional care needs coordinating care across the continuum and engaging with patient and family to assure care needs are met. Serves as a key resource for patients and serves as a consultant to the other care team members regarding patients psychosocial and resource conjunction with the patient and physician the CC SW will assess coordinate and implement a timely safe patient discharge plan to the next appropriate level of care. Overall the role integrates and coordinates the patients transitional care plan into their individualized discharge plans based on needs and resources available.
Specific functions within this role include:
Responsible for providing psychosocial assessments for patients to include timely and appropriate planning to advance the discharge plan.
Assists in relaying information about community-based service offerings (e.g.-indigent care referrals and assistance specialty care or post-acute placements elder assistance etc.) and offers guidance to patients/families to assist with multi-system factors that affect patient/family psychosocial dynamics.
Serves as a specialist on issues related to psychosocial and discharge needs end of life care planning resource needs etc. Will provide resource information necessary to aid patient/families in decision making up to and including support for end of life.
Will partner and offer feedback to the RN Case Manager concerning complex social determinants of health issues situational dynamics and social needs.
May have other duties assigned
Day Shift: Fri; Sat Sun Mon: 7am- 5:30p with holiday rotation
** Contract begins after 12/22/25
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BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I - Basic Life Support - Instructor
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LCSW - Lic Clinical Social Worker GA or LCSW-P - Lic Clinical Social Worker - Provisional (1 Year) within 1 Year
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LMSW - Lic Master Social Worker GA or LMSW-P - Lic Master Social Worker - Provisional (1 Year) within 1 Year
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1 year experience
Description The Care Coordination Social Worker (CC SW) is responsible for assessing transitional care needs coordinating care across the continuum and engaging with patient and family to assure care needs are met. Serves as a key resource for patients and serves as a consultant to the oth...
The Care Coordination Social Worker (CC SW) is responsible for assessing transitional care needs coordinating care across the continuum and engaging with patient and family to assure care needs are met. Serves as a key resource for patients and serves as a consultant to the other care team members regarding patients psychosocial and resource conjunction with the patient and physician the CC SW will assess coordinate and implement a timely safe patient discharge plan to the next appropriate level of care. Overall the role integrates and coordinates the patients transitional care plan into their individualized discharge plans based on needs and resources available.
Specific functions within this role include:
Responsible for providing psychosocial assessments for patients to include timely and appropriate planning to advance the discharge plan.
Assists in relaying information about community-based service offerings (e.g.-indigent care referrals and assistance specialty care or post-acute placements elder assistance etc.) and offers guidance to patients/families to assist with multi-system factors that affect patient/family psychosocial dynamics.
Serves as a specialist on issues related to psychosocial and discharge needs end of life care planning resource needs etc. Will provide resource information necessary to aid patient/families in decision making up to and including support for end of life.
Will partner and offer feedback to the RN Case Manager concerning complex social determinants of health issues situational dynamics and social needs.
May have other duties assigned
Day Shift: Fri; Sat Sun Mon: 7am- 5:30p with holiday rotation
** Contract begins after 12/22/25
-
BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I - Basic Life Support - Instructor
-
LCSW - Lic Clinical Social Worker GA or LCSW-P - Lic Clinical Social Worker - Provisional (1 Year) within 1 Year
-
LMSW - Lic Master Social Worker GA or LMSW-P - Lic Master Social Worker - Provisional (1 Year) within 1 Year
-
1 year experience
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