Discharge Planner & Care Transitions Specialist

Valley Health; Winchester (VA); On-site; USD 36,000 - 55,000; Full time

Benefits offered by this job

Zero-Deductible Health Plan

Dental and vision insurance

Paid Time Off

Tuition Assistance

Retirement Savings Match

Employee Assistance Program

Healthy U Wellness Program

Job summary

Valley Health is seeking a Discharge Planner to provide holistic assessments and develop individualized care plans that address social, emotional, medical, spiritual, and physical needs. You will coordinate care with interdisciplinary teams to ensure safe, timely discharges for medically and socially complex patients, while offering psychosocial support and resource navigation.

Responsibilities include coordinating care, developing discharge plans, educating on resources, and facilitating

Qualifications

• Bachelor’s degree from an accredited social work program or equivalent is required.
• Master’s degree from an accredited social work program or equivalent is preferred.
• BLS Certification required. New hires must have American Heart Association appropriate certification.

Responsibilities

• Coordinate patient care with clinical partners to achieve realistic and desirable outcomes.
• Develop, implement, and communicate discharge plans for medically complex cases, ensuring documentation in the medical record.
• Facilitate interdisciplinary care planning meetings and delegate tasks to support team members.
• Utilize post-acute care facilities and collaborate with financial partners for safe discharge planning.
• Educate patients and families on community resources and assist with referrals for continuity of care.

Skills

Discharge planning

Multidisciplinary teamwork

Crisis intervention

Communication skills

Education

Bachelor’s degree in social work

Master’s degree preferred

Tools

Microsoft Word

Email

Job description

Valley Health is seeking a Discharge Planner to provide holistic assessments and develop individualized care plans that address social, emotional, medical, spiritual, and physical needs. You will coordinate care with interdisciplinary teams to ensure safe, timely discharges for medically and socially complex patients, while offering psychosocial support and resource navigation.

Responsibilities include coordinating care, developing discharge plans, educating on resources, and facilitating