Hospital Social Worker – Care Coordination & Discharge

Advocate Health; Sheboygan (WI); On-site; USD 55,000 - 75,000; Full time

Job summary

Advocate Health seeks a qualified social worker to provide psychosocial assessments, discharge planning, and community resource coordination within a hospital setting.

You will collaborate with multidisciplinary teams, educate patients and families on resources, and navigate regulatory requirements to ensure efficient care transitions. Requires a CSWE-accredited MSW and licensure readiness; NASW Ethics apply.

Qualifications

• Master’s degree in social work from a CSWE accredited school.
• LCSW preferred; IL-LSW eligible; Wisconsin certification preferred.
• Adherence to NASW Code of Ethics.

Responsibilities

• Conducts complete assessments and initiates care plans within desired timeframes.
• Provides psychosocial assessment, needs evaluation, interventions and discharge planning.
• Collaborates with multi-disciplinary team for post-acute placement and community resources.
• Delivers CMS regulatory notices and supports utilization management.
• Educates patients and families on resources, advance directives, and ongoing care needs.
• Documents activity and communicates with payers and care teams to ensure continuity of care.
• Aims to reduce readmissions and coordinate care across the continuum.

Skills

Time management

Professional accountability

Documentation skills

Communication skills

Team collaboration

Safety principles (ACO)

Education

Master’s degree in social work (CSWE accredited)

LCSW preferred / IL-LSW eligible

Wisconsin Social Work Certification

Job description

Advocate Health seeks a qualified social worker to provide psychosocial assessments, discharge planning, and community resource coordination within a hospital setting.

You will collaborate with multidisciplinary teams, educate patients and families on resources, and navigate regulatory requirements to ensure efficient care transitions. Requires a CSWE-accredited MSW and licensure readiness; NASW Ethics apply.