Discharge Planner II: Complex Care Transitions

Valley Health System; United States; On-site; USD 36,000 - 55,000; Full time

Benefits offered by this job

Health insurance

Tuition assistance

Retirement matching

Job summary

Valley Health System is seeking a Discharge Planner II to provide holistic patient assessments and develop individualized care plans that address social, emotional, medical, spiritual, and physical needs. The role focuses on safe, timely discharges for medically and socially complex patients, with emphasis on psychosocial support and resource navigation.

The position requires strong communication, coordination with clinical partners, and documentation in the medical record.

Qualifications

• Bachelor’s degree from an accredited social work program or equivalent required.
• Master’s degree from an accredited social work program or equivalent is preferred.
• Two years of previous social work in a medical setting is required.
• BLS Certification (Basic Life Support) - American Heart ‘Healthcare Provider’ (HCP) - AHA approved required.
• New hires must have American Heart Association (AHA) appropriate certification prior to completion of orientation.

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.
• Educate patients and families on community resources and assist with referrals for continuity of care.
• Maintain contact with referral sources until resources are confirmed, ensuring seamless transitions across the continuum of care.

Skills

Communication skills

Multidisciplinary collaboration

Critical thinking

Time management

Independent work

Documentation

Crisis intervention

Education

Bachelor's degree in social work

Master's degree in social work

Tools

Windows

Microsoft Word

Email

Job description

Valley Health System is seeking a Discharge Planner II to provide holistic patient assessments and develop individualized care plans that address social, emotional, medical, spiritual, and physical needs. The role focuses on safe, timely discharges for medically and socially complex patients, with emphasis on psychosocial support and resource navigation.

The position requires strong communication, coordination with clinical partners, and documentation in the medical record.