Discharge & Care Coordination Specialist

GBMC HealthCare; Baltimore (MD); On-site; USD 58,000 - 94,000; Full time

Job summary

GBMC HealthCare in Baltimore, MD seeks a Social Worker to assess and intervene for seamless post-discharge care. You will interview patients and families, facilitate family meetings, and coordinate continuing care with home health and social services to support effective treatments.

The role requires a Master's in Social Work, Maryland LMSW/LCSW licensure, and 1–3 years of discharge planning experience, working in a multidisciplinary team to ensure timely, patient-centered care.

Qualifications

• Master's degree in Social Work; equivalent experience considered.
• Licensed in Maryland as LMSW or LCSW.
• 1–3 years hospital discharge planning experience preferred.

Responsibilities

• Interview patients and family members/caregivers to identify needs.
• Facilitate family meetings to develop continuing care plans.
• Assess psychosocial needs and promote treatment plan adherence.
• Educate patients and families about community resources and rights.
• Coordinate complex care plans with home health, social services, rehab and mental health providers.

Skills

Cultural competency

Active listening

Open-ended questioning

Empathy

Interviewing

Counseling

Motivational interviewing

EMR proficiency

Education

Master of Social Work

Maryland LMSW or LCSW licensure

Tools

EMR systems

Job description

GBMC HealthCare in Baltimore, MD seeks a Social Worker to assess and intervene for seamless post-discharge care. You will interview patients and families, facilitate family meetings, and coordinate continuing care with home health and social services to support effective treatments.

The role requires a Master's in Social Work, Maryland LMSW/LCSW licensure, and 1–3 years of discharge planning experience, working in a multidisciplinary team to ensure timely, patient-centered care.