Resident Care Social Worker — Discharge & Planning

Atlas Healthcare, LLC; Freneau (NJ); On-site; USD 55,000 - 90,000; Full time

Job summary

Atlas Healthcare, LLC is seeking a Social Worker to oversee the social services component of residents’ care, participate in comprehensive assessments, and contribute to individualized care plans. The role emphasizes advocacy, ethical practice, discharge planning, and collaboration with the care team.

The position involves arranging access to community resources, supporting Advance Care Planning, and ensuring compliance with state and federal regulations. Onboarding will provide further details.

Responsibilities

• Oversee development, implementation, supervision and evaluation of residents' social services.
• Identify medically-related social service needs and ensure services comply with state and federal regulations.
• Complete the social services component of the comprehensive assessment for assigned residents.
• Contribute to and/or direct/ delegate social services goals in the comprehensive care plan.
• Individualize goals to match residents' needs and promote non-pharmacological approaches to care.
• Encourage residents and responsible parties to participate in care plan development and meetings.
• Assist with preadmission services and PASARR Level 1 evaluation.
• Facilitate safe discharge planning and arrangement of community-based services and follow-up care.
• Assist residents and representatives in locating and accessing financial, legal, and community resources.
• Interpret and report social, psychological, and emotional needs to the medical staff and care team.
• Document social service actions in residents' medical records, upholding ethical and professional standards.
• Engage in Advance Care Planning and review Advance Directives regularly.
• Inform staff of residents' code status and end-of-life wishes; educate residents and representatives on options.
• Assist with facility policy development and annual review to improve quality of care.
• Support the Social Services Director to ensure staff knowledge of Residents’ Rights and dignity.
• Advocate for residents and report abuse/neglect/exploitation to the Social Services Director or Administrator and relevant authorities.
• In the absence of the Social Services Director, assume authority and responsibility for directing the Social Services Department.
• Onboarding will provide additional information.

Job description

Atlas Healthcare, LLC is seeking a Social Worker to oversee the social services component of residents’ care, participate in comprehensive assessments, and contribute to individualized care plans. The role emphasizes advocacy, ethical practice, discharge planning, and collaboration with the care team.

The position involves arranging access to community resources, supporting Advance Care Planning, and ensuring compliance with state and federal regulations. Onboarding will provide further details.