Social Worker II - Care Coordination & Discharge Planning

Atrium Health; Winston-Salem (NC); On-site; USD 60,000 - 85,000; Full time

Job summary

Atrium Health is seeking a Social Worker II to provide social work services, complex discharge planning and care coordination for patients and families. You will identify needed community services and refer patients to appropriate resources while communicating psychosocial issues to the hospital team.

You will collaborate with a multidisciplinary team to support patient outcomes, conduct comprehensive psychosocial assessments, develop care plans, provide crisis counseling, coordinate referrals,

Qualifications

• MSW from CSWE-accredited program.
• Preferred healthcare social work experience.
• Licensure or provisional licensure preferred.

Responsibilities

• Identify patients who may benefit from case management services through discharge planning assessment.
• Complete comprehensive psychosocial assessments evaluating emotional, social, environmental, and financial needs.
• Develop, implement, and monitor individualized psychosocial treatment plans.
• Provide crisis intervention, counseling, family counseling, grief support and other interventions.
• Coordinate internal and external referrals to community resources and support services.
• Advocate for patients and families to address unmet needs and remove barriers to care.
• Collaborate with physicians, nurses, and interdisciplinary team on discharge planning.
• Coordinate and facilitate patient and family care conferences as needed.
• Guide patients through post-discharge care options and resources.
• Maintain knowledge of regulations affecting patient care and discharge planning.
• Stay informed on payer requirements and reimbursement practices.
• Identify barriers to efficient care delivery and implement improvements.
• Document assessments, interventions, and care plans in the EMR per standards.

Skills

Assessment skills

Communication

Counseling

Advocacy

Conflict management

Prioritization

Adaptability

Care coordination

Education

MSW (CSWE-accredited)

Job description

Atrium Health is seeking a Social Worker II to provide social work services, complex discharge planning and care coordination for patients and families. You will identify needed community services and refer patients to appropriate resources while communicating psychosocial issues to the hospital team.

You will collaborate with a multidisciplinary team to support patient outcomes, conduct comprehensive psychosocial assessments, develop care plans, provide crisis counseling, coordinate referrals,