Inpatient Social Worker: Care Coordination & Discharge

Aurora Health Care; Cudahy (WI); On-site; USD 65,000 - 85,000; Full time

Job summary

Aurora Health Care is seeking a skilled social worker to provide psychosocial assessments, discharge planning, and care coordination across the hospital stay. You will collaborate with the care team, advocate for patients and families, coordinate post-acute placements, and ensure compliance with CMS and regulatory requirements while maintaining up-to-date knowledge of community resources.

This role requires engagement with multidisciplinary teams, documentation excellence, and sensitivity to

Qualifications

• Master’s degree in social work from a CSWE accredited school.
• Years of Experience: Typically requires 2 years of social work experience in healthcare.
• IL‑LSW Eligible, LCSW preferred issued by the State of Illinois
• WI‑Social Work Certification issued by the State of Wisconsin
• CLT‑ Masters in Social Work required, LCSW preferred. applicable state Certification is preferred.
• GA‑ applicable state Certification is preferred. Adherence to National Association of Social Workers Code of Ethics.

Responsibilities

• Provide social work services including psychosocial assessment, screening, determination of needs evaluation, appropriate interventions and follow up, and discharge planning.
• Collaborate with the multi-disciplinary health care team to develop safe and timely coordination of care including post-acute placement and community resources.
• Complete UM activities including providing clinical updates to payers and external review organizations, collecting data, coordinating denial activity, and managing delays.
• Communicate effectively with the healthcare team and participate in care coordination to establish a safe plan of care.
• Educate patients and families about resources, advance directives, and post-discharge options; ensure compliance with regulations and accreditation standards.
• Document activity according to protocols, support LOS optimization, and ensure continuity of care across the continuum.

Skills

Psychosocial assessment & planning

Discharge planning

Care coordination

Regulatory compliance & CMS knowledge

Team communication & collaboration

Education

Master's degree in Social Work (CSWE-accredited)

IL-LSW eligibility / LCSW preferred

Wisconsin Social Work Certification

2 years healthcare social work experience

Job description

Aurora Health Care is seeking a skilled social worker to provide psychosocial assessments, discharge planning, and care coordination across the hospital stay. You will collaborate with the care team, advocate for patients and families, coordinate post-acute placements, and ensure compliance with CMS and regulatory requirements while maintaining up-to-date knowledge of community resources.

This role requires engagement with multidisciplinary teams, documentation excellence, and sensitivity to