Social Services Coordinator - SNF Avamere Rehab King City

Avamere Skilled Advisors, LLC; Tigard (OR); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

Health Insurance

401(k) Plan

Paid Time Off (PTO)

EAP Canopy with telehealth

Continuing Education Reimbursement

Referral bonus program

Flexible Spending Accounts & CERA

Job summary

Avamere Rehab seeks a Social Services Coordinator to ensure medically related emotional and psychosocial needs are met. You will liaise with residents, families, providers, and payors, coordinate discharge planning, and work with the interdisciplinary team to create and update care plans.

The role requires collaboration with social services leadership, EMR experience, and prior SNF health care exposure, ensuring compliant, person-centered care and smooth transitions.

Qualifications

• Prefer bachelor’s degree in public health administration, social work or a related field.
• Experience working with electronic medical records and computer documentation systems.
• 1 year of experience in a skilled nursing facility or similar health care setting.

Responsibilities

• Identifies residents’ emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date.
• Collaborates with the Social Services Director and interdisciplinary team to coordinate discharge plans, barriers, and needs for safe discharge.
• Communicates with residents, families, providers, and payors on a consistent and timely basis.
• Acts as the resident advocate to uphold rights and ensure best interests are served.
• Coordinates with community support services to secure post-discharge supports and services.
• Arranges for ancillary services during stay and coordinates transportation to appointments as needed.
• Leads regular care conferences with residents, families, and the team; monitors mood and behavior; supports mental health needs.
• Assists with Medicaid applications and spend downs; guides placement decisions after discharge.
• Maintains grievance records and assists residents with personal item security.
• Participates in facility quality assurance and other required meetings.

Skills

Communication

Care coordination

Advocacy

Discharge planning

Interdisciplinary collaboration

Education

Bachelor's degree in public health administration, social work or related field

Tools

Electronic Medical Records (EMR)

Computer documentation systems

Job description

Social Services Coordinator

Status: Full-Time

Schedule: Days

Location: Avamere Rehab of King City, 16485 SW Pacific Hwy, Tigard, OR 97224

The Social Services Coordinator works under the supervision of the Social Services Director and in accordance with current federal, state, and local standards, guidelines, and regulations, as well as Avamere’s established policies and procedures, to ensure that the medically related emotional, mental, and psychosocial needs of the residents are met. Additionally, the Social Services Coordinator acts as a liaison between the resident/family and community partners, providers, and payors to ensure safe discharge planning and continuation of care.

Essential Duties and Job Responsibilities

• Identifies residents’ emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date
• Works with the Social Services Director and interdisciplinary team to identify discharge plans, barriers, and needs to effectively coordinate a safe discharge from the facility
• Communicates with residents, families, community providers and programs, and any other parties, on a consistent and timely basis
• Acts as the resident advocate by ensuring that their resident rights are upheld and that all parties are acting in the best interest of the resident
• Coordinates with community support services such as home health, hospice, and durable medical services to ensure that residents have the supports and services they need post-discharge
• Arranges for provision of ancillary services for residents while they are in the facility including transportation to/from ancillary appointments
• Coordinates and conducts regular care conferences with residents and families as well as other meetings as needed
• Monitors residents’ mood and behaviors, creates behavioral care plans as appropriate, and assists residents in seeking mental health supports and services if needed
• Works with insurance companies and other payors to ensure payment for skilled nursing and/or long-term care services and issues non-coverage notices on behalf of Medicare and insurance companies
• Assists residents and families in applying for Medicaid services, including spend downs
• Assists residents and families in finding appropriate placement in outside facilities following discharge from Avamere facilities
• Acts as the point person and record keeper for grievance and lost items
• Assists residents in obtaining clothing and other personal items as needed
• Participates in facility quality assurance program and other meetings as required
• Performs other duties as assigned

• Prefer bachelor’s degree in public health administration, social work or a related field
• Experience working with electronic medical records and computer documentation systems
• 1 year of experience in a skilled nursing facility or similar health care setting

• Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible.
• 401 (k) Plan: After 90 days of employment, with matching program.
• Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave.
• EAP Canopy with unlimited telehealth mental health visits.
• Continuing Education and Higher Education Reimbursement.
• Generous employee referral bonus program.
• Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account).
• Professional Development: Opportunities for growth and development within the company.
• Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more.

Avamere is an Equal Opportunity Employer and participates in E-Verify.

#ARKC