Social Work Navigator: Discharge & Community Resources

Trinity Health; Waterloo (AL); On-site; USD 52,000 - 72,000; Full time

Job summary

Trinity Health’s MercyOne Waterloo Medical Center is seeking a Social Worker to provide psychosocial assessments, counseling, crisis intervention, and resource coordination across the care continuum. The role focuses on social determinants of health, behavioral health needs, and discharge barriers to ensure safe transitions of care.

Responsibilities include coordinating resources, collaborating with interdisciplinary teams, and supporting high-risk patients and families through discharge

Qualifications

• Bachelor's degree in Social Work (BSW) from an accredited program.
• Current Iowa licensure as required for BSW-level practice (if applicable based on state regulations) or eligibility to obtain within a defined timeframe.
• One year of relevant healthcare, care management, behavioral health, or community-based services preferred.

Responsibilities

• Conduct comprehensive psychosocial assessments addressing emotional, social, financial, and environmental needs.
• Provide counseling, crisis intervention, grief support, and assistance with coping strategies for patients and families.
• Identify and address barriers to discharge related to behavioral health, housing, safety, substance use, domestic violence, guardianship, or protective services.
• Coordinate community resources, including mental health services, substance use programs, transportation, shelters, and financial assistance.
• Collaborate with Care Managers, providers, and interdisciplinary teams to develop safe transition plans for high-risk or vulnerable patients.

Skills

Psychosocial assessment

Counseling

Discharge planning

Care coordination

Interdisciplinary collaboration

Communication

Organizational skills

Education

Bachelor's degree in Social Work (BSW)

Job description

Trinity Health’s MercyOne Waterloo Medical Center is seeking a Social Worker to provide psychosocial assessments, counseling, crisis intervention, and resource coordination across the care continuum. The role focuses on social determinants of health, behavioral health needs, and discharge barriers to ensure safe transitions of care.

Responsibilities include coordinating resources, collaborating with interdisciplinary teams, and supporting high-risk patients and families through discharge