Social Worker II: Care Coordination & Discharge Planning

Advocate Health; North Carolina; Hybrid; USD 55,000 - 75,000; Full time

Job summary

Advocate Health is seeking a Social Worker II to provide comprehensive social work services, complex discharge planning, and care coordination for patients and families. You will identify community resources, refer patients in need, and communicate psychosocial issues to the hospital team to improve outcomes.

You’ll collaborate with a multidisciplinary team, assess psychosocial needs, develop individualized plans, and advocate for patients to overcome barriers to care while staying current with

Qualifications

• Master's Degree in Social Work (MSW) from CSWE-accredited program.
• Strong clinical assessment and care coordination capabilities.
• Familiarity with discharge planning and community resource referrals.

Responsibilities

• Identify patients who may benefit from case management through discharge planning assessment.
• Complete psychosocial assessments to evaluate emotional, social, and financial needs.
• Develop, implement, and monitor psychosocial treatment plans.
• Provide crisis intervention, counseling, and family support.
• Coordinate internal and external referrals to community resources.
• Advocate for patients and families to address barriers to care.
• Collaborate with physicians, nurses, and the multidisciplinary team to support discharge planning.
• Facilitate patient and family care conferences as needed.
• Guide patients through post-discharge options and resources.
• Maintain knowledge of regulations affecting patient care and discharge planning.
• Document assessments, interventions, and care plans in the EMR.

Skills

Assessment skills

Communication skills

Counseling skills

Advocacy skills

Relationship building

Conflict management

Prioritization in fast-paced settings

Adaptability in healthcare

Community resources knowledge

Education

MSW (CSWE-accredited)

Job description

Advocate Health is seeking a Social Worker II to provide comprehensive social work services, complex discharge planning, and care coordination for patients and families. You will identify community resources, refer patients in need, and communicate psychosocial issues to the hospital team to improve outcomes.

You’ll collaborate with a multidisciplinary team, assess psychosocial needs, develop individualized plans, and advocate for patients to overcome barriers to care while staying current with