Field Social Worker & Care Coordination Specialist

Your Health Organization; Blythewood (SC); On-site; USD 52,000 - 64,000; Full time

Job summary

Your Health Organization in Columbia area is seeking a Social Worker to support patients across multiple facilities and homes. The role involves home and facility visits, coordinating placements, and managing care plans.

Daily visits, travel is required, and the position is full-time, typically 8-hour shifts, Monday through Friday. The Social Worker will initiate advance care planning, perform comprehensive assessments, and collaborate with care teams to deliver compassionate, coordinated care

Qualifications

• Qualified Social Worker with licensure to practice
• Excellent customer service and interpersonal skills
• Ability to work across multiple facilities and home settings

Responsibilities

• Initiate Advance Care Planning for patients across assigned Care Team and facilities.
• Complete Daily Comprehensive Assessments for patients.
• Develop and update Daily Care Plans for patients.
• Document Chronic Care Management time daily.
• Meet Daily Productivity goals.
• Coordinate discharges at contracted facilities.
• Arrange placement as needed.
• Ensure continuity of care during acute visits or changes in meds.
• Build and maintain professional relationships with referral sources.
• Maintain clear communication with patients, families, and Care Teams.

Job description

Your Health Organization in Columbia area is seeking a Social Worker to support patients across multiple facilities and homes. The role involves home and facility visits, coordinating placements, and managing care plans.

Daily visits, travel is required, and the position is full-time, typically 8-hour shifts, Monday through Friday. The Social Worker will initiate advance care planning, perform comprehensive assessments, and collaborate with care teams to deliver compassionate, coordinated care