SNF Social Worker — Resident Support & Care Coordination

Hc; New York (NY); On-site; USD 60,000 - 72,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Paid Time Off

401(k) Retirement Plan

Opportunities for career growth andadv

Opportunities for career growth andAdv

Job summary

Hc in New York is seeking a compassionate Social Worker to join our Skilled Nursing Facility care team. This full‑time role focuses on addressing residents’ psychosocial needs, coordinating care plans, and guiding transitions from admission to discharge.

Responsibilities include evaluating needs, developing plans with the clinical team, coordinating admissions and discharge, and counseling residents and families. EMR familiarity and PCC/MDS 3.0 experience are a plus.

Qualifications

• Bachelor’s degree in Social Work (BSW) or related field required; MSW preferred.
• Prior experience in a skilled nursing facility, rehabilitation center, or long-term care setting preferred.
• Strong communication and interpersonal skills; familiarity with discharge planning and community resources.
• Experience with EMR systems; PCC and MDS 3.0 experience a plus.

Responsibilities

• Evaluate residents’ social, emotional, and psychological needs.
• Develop and implement individualized care plans in collaboration with the clinical team.
• Participate in interdisciplinary care plan meetings.
• Coordinate admissions, transfers, and discharge planning.
• Assist with arranging home care services, DME, and community resources.
• Provide counseling and support to residents and their families.
• Ensure residents’ rights are maintained and advocate for their well-being.
• Assist with financial documentation and educate residents/families on available resources.
• Maintain accurate and timely documentation in accordance with regulatory standards.

Skills

Strong communication

Discharge planning knowledge

Multitasking in fast-paced environment

Interpersonal skills

Education

Bachelor’s Degree in Social Work (BSW) or related field

MSW preferred

Tools

PCC

MDS 3.0

Job description

Hc in New York is seeking a compassionate Social Worker to join our Skilled Nursing Facility care team. This full‑time role focuses on addressing residents’ psychosocial needs, coordinating care plans, and guiding transitions from admission to discharge.

Responsibilities include evaluating needs, developing plans with the clinical team, coordinating admissions and discharge, and counseling residents and families. EMR familiarity and PCC/MDS 3.0 experience are a plus.