Social Worker & Care Coordination (Home & Facility Visits)

Your Health Organization; West Columbia (SC); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Competitive compensation package

Employer matched 401K

Free visit & prescriptive services

Employer matched HSA

Generous PTO

Job summary

Your Health Organization in Columbia, SC seeks a qualified Social Worker to assist our patients across multiple facilities and homes in the area. This is a full-time role with daily travel to homes and facilities in the designated service area.

You will initiate Advance Care Planning, complete daily assessments and care plans, and document Chronic Care Management time. You will coordinate discharges and placements while building strong relationships with referral sources and care teams.

Qualifications

• Qualified Social Worker with a degree in Social Work or equivalent.
• Experience delivering patient-centered care and coordinating with facilities.

Responsibilities

• Initiate Advance Care Planning for patients across assigned teams.
• Complete Daily Comprehensive Assessments on patients.
• Create Daily Care Plans for patients.
• Document Chronic Care Management time daily.
• Meet Daily Productivity Goals.
• Coordinate discharges at contracted facilities.
• Coordinate placement and transitions of care.
• Maintain continuity of coverage for acute visits and med changes.
• Build relationships with referral sources and care teams.
• Communicate professionally with patients, families and teams.

Skills

Social Work

Home visits

Care planning

Patient advocacy

Education

Social Work degree

Job description

Your Health Organization in Columbia, SC seeks a qualified Social Worker to assist our patients across multiple facilities and homes in the area. This is a full-time role with daily travel to homes and facilities in the designated service area.

You will initiate Advance Care Planning, complete daily assessments and care plans, and document Chronic Care Management time. You will coordinate discharges and placements while building strong relationships with referral sources and care teams.