Discharge Planner & Care Transition Social Worker

Center Management Group; New York (NY); On-site; USD 65,000 - 85,000; Full time

Job summary

Fairview Skilled Rehabilitation & Nursing Center seeks a compassionate Discharge Planner / Social Worker to coordinate safe discharges for residents, working with families, physicians, nursing, therapy, and community providers to ensure smooth transitions.

The role includes psychosocial assessments, arranging home care and services, and maintaining compliant documentation while collaborating in care plan meetings with the interdisciplinary team.

Qualifications

• MSW degree or higher preferred.
• LMSW/LCSW licensure preferred.
• Experience with discharge planning in related settings.
• Knowledge of Medicare/Medicaid procedures and regulations.

Responsibilities

• Coordinate discharge planning from admission through discharge.
• Complete psychosocial assessments and provide emotional support.
• Arrange home care, equipment, transportation, and community services.
• Communicate with hospitals, physicians, insurers, and providers.
• Maintain documentation and ensure compliance with regulations.
• Participate in care plan meetings with the interdisciplinary team.

Skills

Discharge planning

Communication

Teamwork

Organizational skills

Medicare/Medicaid knowledge

Education

MSW

LMSW/LCSW preferred

Job description

Fairview Skilled Rehabilitation & Nursing Center seeks a compassionate Discharge Planner / Social Worker to coordinate safe discharges for residents, working with families, physicians, nursing, therapy, and community providers to ensure smooth transitions.

The role includes psychosocial assessments, arranging home care and services, and maintaining compliant documentation while collaborating in care plan meetings with the interdisciplinary team.