Clinical Social Worker, Inpatient Care Coordination

Moab Regional Hospital • Moab, UT

2d • Onsite

About The Position

The Clinical Social Worker is a key member of the care coordination team and supports the total care plan for patients and families across the organization. This role primarily serves the 17-bed inpatient medical-surgical floor, with additional support to hospice and other patient care venues as needed. The position focuses on identifying and addressing social, emotional, practical, and community-based barriers to care, coordinating with case management, discharge planning, and community liaisons to support safe and effective transitions of care. This role concentrates on psychosocial assessment, resource navigation, problem-solving, patient and family support, crisis de-escalation within scope, and coordination of services that promote safe discharge and continuity of care.

Requirements

• Master of Social Work degree from a CSWE-accredited program.
• Current Utah licensure as an LCSW preferred.
• Utah CSW is eligible if supervision requirements are met and the candidate is able to practice under approved supervision.
• Experience in a hospital, hospice, long-term care, or other healthcare setting preferred.
• Strong communication, collaboration, organization, and problem-solving skills.
• Ability to work effectively with patients, families, providers, and community partners in a rural/critical access environment.

Nice To Haves

• Prior inpatient medical-surgical social work experience.
• Experience with discharge planning, hospice, insurance offerings, or care transitions.
• Knowledge of community resources in rural Utah or comparable settings.
• Comfort working in a broad, adaptable role with varied patient needs.

Responsibilities

• Complete psychosocial assessments for admitted patients and families to identify social risks, support systems, barriers to discharge, and community resource needs.
• Collaborate with nurses, physicians, case managers, discharge planners, and community liaisons to support an integrated care plan.
• Assist patients and families with discharge planning, placement coordination, resource referrals, transportation planning, caregiver support, and navigation of local services.
• Support hospice and end-of-life care needs, including family meetings, advance care planning support, grief-related support within scope, and coordination of practical needs.
• Address social determinants of health that may affect recovery, safety, and follow-through after discharge.
• Provide brief, supportive, problem-solving interventions related to illness adjustment, coping, communication, and decision-making within the scope of hospital social work practice.
• Participate in interdisciplinary rounds, care conferences, and discharge discussions as appropriate.
• Connect patients and families to community resources, financial, housing, legal, behavioral health, caregiving, and faith/community supports as indicated.
• Document assessments, interventions, referrals, and care coordination activities in the medical record according to hospital policy and professional standards.
• Serve as a resource to staff regarding psychosocial issues, family dynamics, community support, and barriers to discharge.

Benefits

• Medical Insurance
• Mental health coverage for entire family
• Retirement 403b
• Paid time off
• Professional growth opportunities including continuing education, trainings, and more!

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level