PRN Renal Social Worker

Concerto Renal Services; Fort Wayne (IN); On-site; USD 41,000 - 52,000; Full time

Job summary

Concerto Renal Services seeks a PRN Social Worker to provide psychosocial evaluations, counseling and quality-of-life support to dialysis patients in skilled nursing or rehab facilities. As part of the interdisciplinary team, you address psychosocial needs, ensure timely care planning per CMS guidelines, and maintain detailed documentation to meet QAPI standards.

The position reports to the market Team Lead and the Director of Social Services.

Qualifications

• Provide psychosocial evaluations and counseling for dialysis patients.
• Develop individualized care plans with the interdisciplinary team.
• Ensure CMS guidelines compliance and quality assurance.
• Maintain detailed EMR documentation.

Responsibilities

• Patient assessment & care planning with psychosocial evaluations.
• Provide counseling on dialysis options and advance directives.
• Lead monthly care plan meetings with clinical staff.
• Coordinate with facility teams, EQRS specialists, and regional managers.
• Support new clinic openings and admissions.
• Maintain compliant documentation for CMS and Concerto policies.
• Advocate for patients and coordinate community resources.

Tools

EMR systems

Job description

Why Work at Concerto? What is in it for you?

• Clinical/Corporate Career Advancement
• Flexible Schedule
• Minimum of two (2) monthly shift pick ups

Who Are We?

Concerto Renal Services is an industry leader in sub-acute hemodialysis within a skilled nursing facility and/or long-term care facility. We are a rapidly expanding business with a simple mission: reimagining dialysis care, one community at a time. Our model focuses on ensuring those with end-stage renal disease receive the best possible care through a more convenient, centralized, continuous care model.

Why is this Role Essential?

Concerto is seeking a PRN Social Worker to join its team!This role provides psychosocial evaluations, counseling, and quality-of-life support to dialysis patients in Skilled Nursing or rehab facilities. As part of the interdisciplinary team, the PRN Social Worker addresses psychosocial needs, ensures timely care planning per CMS guidelines, and maintains detailed documentation to meet QAPI standards. The position reports to the market Team Lead and indirectly to the Director of Social Services.

What Will You Do?

1. Patient Assessment & Care Planning
   Conducts psychosocial assessments (initial, 90-day, annual, and as-needed), administers quality-of-life and depression screenings (KDQOL, PHQ-2/9), and develops individualized care plans in collaboration with the interdisciplinary team.
2. Therapeutic Support & Education
   Provides counseling and education on dialysis, transplant options, and advance directives; delivers interventions to support treatment compliance and quality of life; and develops patient education materials.
3. Interdisciplinary Collaboration
   Leads monthly care plan meetings with patients and clinical staff, coordinates with facility teams, EQRS specialists, and regional managers, and supports new clinic openings and admissions.
4. Documentation & Compliance

Maintains accurate EMR documentation of assessments, interventions, and follow-ups; tracks and reports productivity and outcomes; and ensures compliance with CMS guidelines and Concerto policies.

1. Advocacy & Resource Coordination
   Addresses patient and family concerns, assists with outpatient dialysis placement and discharge planning, and connects patients with community resources while supporting grievance reporting.