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Wellstar Health System is seeking a Care Coordination Social Worker to assess transitional care needs, coordinate discharge planning, and support patients and families across the care continuum.
You will partner with RNs, physicians, and the care team to identify barriers, connect patients with community resources, and ensure timely, safe discharge plans aligned with patient wishes and goals; you will advocate for culturally sensitive, patient-centered care throughout the process.
locationsPaulding Hospital
time typeFull time
How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
Day (United States of America)
The Care Coordination Social Worker (CC SW) is responsible for assessing transitional care needs, coordinating care across the continuum, and engaging with patient and family to assure care needs are met. Serves as a key resource for patients and serves as a consultant to the other care team members regarding patient's psychosocial and resource needs. In conjunction with the patient and physician, the CC SW will assess, coordinate, and implement a timely, safe patient discharge plan to the next appropriate level of care. Overall, the role integrates and coordinates the patients transitional care plan into their individualized discharge plans based on needs and resources available. Specific functions within this role include: Responsible for providing psychosocial assessments for patients to include timely and appropriate planning to advance the discharge plan. Assists in relaying information about community-based service offerings (e.g.-indigent care referrals and assistance, specialty care or post-acute placements, elder assistance, etc.) and offers guidance to patients/families to assist with multi-system factors that affect patient/family psychosocial dynamics. Serves as a specialist on issues related to psychosocial and discharge needs, end of life care planning, resource needs, etc. Will provide resource information necessary to aid patient/families in decision making up to and including support for end of life. Will partner and offer feedback to the RN Case Manager concerning complex social determinants of health issues, situational dynamics, and social needs. May have other duties assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.
Minimum 1 year experience in healthcare in the acute care setting, related field or skilled care environment or community or educational internship in care coordination. Required andA background in medical social work in an acute care setting is highly Preferred
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