Discharge Planner & Social Services Advocate

PACS; San Francisco (CA); On-site; USD 41,000 - 55,000; Full time

Job summary

San Francisco Post Acute in San Francisco, CA is seeking a compassionate Social Services / Discharge Planner to join our full-time team. You will support residents and families throughout the care journey, helping navigate healthcare needs, access community resources, and prepare for safe transitions after discharge.

Collaborate with the interdisciplinary team to promote independence and well-being. Qualified candidates will have a background in social work, strong communication, and the ability

Qualifications

• Bachelor’s degree in Social Work or Human Services preferred.
• At least two years of supervised social work experience in a healthcare setting.
• MSW preferred.
• Experience in skilled nursing or discharge planning preferred.
• Knowledge of PointClickCare (PCC) preferred.
• Excellent organizational, planning, documentation, and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to manage competing priorities while maintaining professionalism, confidentiality, and compassion.

Responsibilities

• Assess residents’ social, emotional, psychological, and family needs to develop individualized social services plans.
• Provide emotional support and counseling to residents and families as they navigate illness, physical limitations, grief, and changes in independence.
• Assist residents in achieving the highest practicable level of independence, self-care, and overall well-being.
• Coordinate discharge planning with residents, families, healthcare providers, community agencies, and the interdisciplinary team.
• Arrange referrals, community services, medical equipment, assistive devices, and other resources needed for safe transitions to home or another care setting.
• Help residents and families understand available care options and make informed healthcare decisions.
• Coordinate outpatient appointments and on-site ancillary services, including optometry, podiatry, dental, and psychiatric services.
• Assist with obtaining community, social service, health, and welfare resources to meet residents’ needs.
• Support the tracking of resident belongings and help resolve concerns involving missing, lost, or stolen items.
• Maintain accurate and timely documentation of resident social services needs, interventions, and discharge plans.
• Build strong working relationships with facility departments and external community partners.
• Provide staff education and in-service training as requested.
• Maintain resident confidentiality and uphold residents’ rights and dignity.
• Perform other duties as assigned.

Skills

Organizational skills

Communication skills

Problem-solving

Prioritization

Education

Bachelor's degree in Social Work or Human Services

Master of Social Work (MSW) preferred

Tools

PointClickCare (PCC)

Job description

San Francisco Post Acute in San Francisco, CA is seeking a compassionate Social Services / Discharge Planner to join our full-time team. You will support residents and families throughout the care journey, helping navigate healthcare needs, access community resources, and prepare for safe transitions after discharge.

Collaborate with the interdisciplinary team to promote independence and well-being. Qualified candidates will have a background in social work, strong communication, and the ability