Discharge Planner & Social Services Assistant

Potomac Valley Rehabilitation and Healthcare Center; Rockville (MD); On-site; USD 55,000 - 75,000; Full time

Job summary

Potomac Valley Rehabilitation and Healthcare Center in Rockville, MD seeks a Discharge Planner & Social Services Assistant to coordinate discharge plans and connect residents with follow-up services. The role involves psychosocial assessments, trauma screening, and documenting care plans.

You will work with nursing, therapy, and administrative staff to promote timely, safe discharges while supporting residents and families with education and advocacy through the transition to home or other

Qualifications

• Experience in discharge planning or social services within healthcare settings.
• Knowledge of community resources and post-acute care options.
• Strong communication and interpersonal skills with residents and families.
• Organizational and time-management abilities.
• Proficiency with EHR and standard office software.
• Social Work education; licensure in social services or pursuing licensure.
• Prior SNF or rehabilitation center experience preferred.

Responsibilities

• Coordinate discharge plans and follow-up services for residents.
• Conduct psychosocial assessments and trauma screens as part of care planning.
• Maintain accurate documentation and update care plans as needed.
• Collaborate with nursing, therapy, and administrative staff to ensure safe discharges.
• Provide education, advocacy, and emotional support to residents and families.

Skills

Discharge planning

Communication skills

Time management

EHR proficiency

Interpersonal skills

Licensure in social work

SNF experience

Education

Bachelor's or Master's in Social Work

Tools

Electronic Health Records

Job description

Company Description

Potomac Valley Rehabilitation and Healthcare Center is a skilled nursing and rehabilitation facility serving individuals who need short-term recovery support. The center focuses on person-centered services that promote dignity, comfort, and quality of life for residents and their families. Interdisciplinary teams collaborate to provide comprehensive medical, therapeutic, and social support tailored to each individual’s needs. The organization values compassionate care, professional growth, and a collaborative work environment that supports both staff and residents.

Education Requirenments

Bachelors or Masters in Social Work.

Role Description

The Discharge Planner & Social Services Assistant is a full-time, on-site role based in Rockville, MD, supporting residents and families as they transition between the facility, home, and other care settings.

Day-to-day responsibilities include coordinating discharge plans, arranging follow-up services, and ensuring residents have access to necessary community resources and support.

The role involves conducting psychosocial assessments, trauma screens, participating in interdisciplinary care planning meetings, and maintaining accurate documentation of resident needs and service by updating care plans as needed.

This position also provides emotional support, education, and advocacy for residents and families, helping them navigate healthcare options, insurance questions, and social service programs.

The Discharge Planner & Social Services Assistant collaborates closely with nursing, therapy, and administrative staff to promote safe, effective, and timely discharges.

Qualifications

• Experience in discharge planning, case management, or social services within a rehabilitation, long-term care, or healthcare setting is a plus.
• Knowledge of community resources, home health services, and post-acute care options, including coordination with external providers and agencies.
• Strong communication and interpersonal skills for working with residents, families, and interdisciplinary team members.
• Organizational and time-management skills to handle multiple cases, documentation requirements, and deadlines.Ability to handle sensitive information with discretion and maintain compliance with privacy and regulatory standards.
• Basic proficiency with electronic health records and standard office software for documentation and reporting.
• Relevant education in Social Work; licensure in social services or plan to acquire bachelor or master level licensure.
• Prior experience in a skilled nursing facility or rehabilitation center is preferred but not required.