Discharge Planner & Social Worker: Seamless Transitions

Advanced Health Care; Sharonville (OH); On-site; USD 60,000 - 80,000; Full time

Job summary

Advanced Health Care is seeking a Discharge Planner / Social Worker to oversee safe and efficient discharge of residents. The role requires collaboration with physicians, therapists, social workers, and families to develop individualized discharge plans and ensure smooth transitions.

The position emphasizes strong clinical skills, excellent communication, and commitment to resident care. Schedule is full-time on weekdays, with 8–9 hour shifts, and in-facility duties across nursing floors and

Qualifications

• 1+ years of experience in a Skilled Nursing Facility (required).
• Organization skills.
• Knowledge of community resources and support services for older adults.
• Knowledge of medical terminology, charting, and SNF familiarity.
• Strong written and verbal communication skills.
• Basic knowledge of Microsoft Office applications.
• Ability to build rapport with patients with compassion.
• Leadership and supervision abilities.
• Commitment to ongoing professional development and nursing standards.

Responsibilities

• Oversee the discharge planning process across the healthcare team.
• Assess residents’ discharge needs including meds, equipment, post‑discharge care.
• Develop individualized discharge plans with residents, families, and caregivers.
• Educate residents and families on medications, follow-ups, and care.
• Coordinate with community resources and home health agencies for services.
• Arrange transportation for discharge when needed.
• Complete discharge paperwork and ensure documentation is accurate.
• Monitor residents’ condition and respond to issues during discharge.
• Collaborate with Nursing leadership to meet regulatory policies.
• Participate in team meetings to discuss discharge plans and barriers.
• Perform other duties as directed by the Director of Nursing.

Skills

Organization

Community resources knowledge

Medical terminology & charting

Written and verbal communication

MS Office basics

Compassionate patient rapport

Leadership & supervision

Professional development & nursing

Tools

MS Office

Job description

Advanced Health Care is seeking a Discharge Planner / Social Worker to oversee safe and efficient discharge of residents. The role requires collaboration with physicians, therapists, social workers, and families to develop individualized discharge plans and ensure smooth transitions.

The position emphasizes strong clinical skills, excellent communication, and commitment to resident care. Schedule is full-time on weekdays, with 8–9 hour shifts, and in-facility duties across nursing floors and