PRN Social Worker: Care Coordinator & Discharge Planner

Johns Hopkins Medicine; Baltimore (MD); On-site; USD 1,400 - 62,000; Full time

Job summary

Johns Hopkins Medicine Social Work is seeking a PRN Social Worker II to provide short-term psychosocial support, care coordination, and discharge planning in collaboration with patients, families, physicians, and the interdisciplinary care team.

The role assesses patient needs, identifies barriers to care, develops intervention plans, and connects patients and families with appropriate resources to support safe, effective transitions of care. Coverage may be required as needed.

Qualifications

• MSW required.
• Valid LCSW-C required.
• Strong clinical assessment, counseling, and care coordination skills.
• Knowledge of community resources and psychosocial factors affecting patient care.
• Excellent communication, documentation, and collaboration skills.
• Ability to work independently in a healthcare setting with minimal supervision.

Responsibilities

• Complete psychosocial screenings, assessments, and care plans for patients and families with social work needs.
• Provide crisis intervention, grief counseling, abuse/neglect reporting, and other immediate psychosocial support.
• Develop discharge and transition plans to address psychosocial barriers and improve patient outcomes.
• Collaborate with the interdisciplinary team to coordinate care and support treatment goals.
• Connect patients and families with community, financial, legal, and behavioral health resources.
• Facilitate family meetings and participate in care conferences and interdisciplinary rounds as needed.
• Maintain timely, accurate documentation in the medical record; support quality improvement efforts and serve as a clinical resource.
• Provide coverage as needed, including absences, vacancies, and on-call support.
• Other duties as assigned.

Skills

Clinical assessment

Counseling

Care coordination

Education

Master of Social Work (MSW)

Licensed Clinical Social Worker-C (LCSW-C)

Job description

Johns Hopkins Medicine Social Work is seeking a PRN Social Worker II to provide short-term psychosocial support, care coordination, and discharge planning in collaboration with patients, families, physicians, and the interdisciplinary care team.

The role assesses patient needs, identifies barriers to care, develops intervention plans, and connects patients and families with appropriate resources to support safe, effective transitions of care. Coverage may be required as needed.