Discharge Planner / Social Worker

Advanced Health Care of Cincinnati•Sharonville, OH

4d•Onsite

About The Position

The Discharge Planner / Social Worker oversees and coordinates the safe and efficient discharge of residents from the facility. The role requires clinical skills, strong communication, and a commitment to exceptional resident care. The position is full-time, weekdays (Monday through Friday), with 8–9-hour shifts. The position works in person with residents and their families in a medical setting, including resident rooms, common areas, and administrative offices. It involves coordinating with the healthcare team and community providers, arranging discharge services and transportation, educating residents and families, completing discharge documentation, and monitoring residents during the discharge process. The role also supports compliance with regulatory requirements and facility policies and performs other duties assigned by the Director of Nursing.

Requirements

At least 1 year of experience in a skilled nursing facility.
Organizational skills.
Knowledge of community resources and support services available to older adults.
Knowledge of medical terminology and charting skills, and familiarity with a skilled nursing facility.
Strong written and verbal communication skills.
Basic knowledge of Microsoft Office applications and computer hardware and software.
Ability to build rapport with patients through a compassionate and caring demeanor.
Demonstrated leadership and management skills, with the ability to mentor and supervise staff as needed.
Commitment to ongoing professional development and adherence to high standards of nursing practice.
Ability to work in person with residents and families in a medical setting and across facility areas.
Ability to sit, stand, bend, reach, talk, hear, stoop, kneel, crouch, stretch, twist, use hands and fingers, and handle or operate objects, equipment, or controls.
Vision requirements include close, distance, and peripheral vision and the ability to adjust focus.
Emotional resilience and ability to cope with the physical and emotional demands of working with residents with complex healthcare needs.
Stamina to stand and move around the facility for frequent rounds and to respond to emergent situations as needed.
Ability to lift and/or assist nursing staff in safely transferring residents, using proper body mechanics and assistance as needed.
Ability to exert maximum muscle force to lift, push, pull, or carry objects.

Responsibilities

Supervise and coordinate resident discharge planning in collaboration with physicians, therapists, social workers, and family members.
Assess residents’ discharge needs, including medication reconciliation, equipment requirements, and post-discharge care arrangements.
Develop individualized discharge plans with residents, families, and caregivers that address preferences, goals, and clinical needs.
Educate residents and families about care, medications, follow-up appointments, and other necessary information.
Coordinate services with community resources, home health agencies, durable medical equipment providers, and other healthcare professionals.
Arrange transportation for residents’ discharge as needed.
Complete discharge paperwork and obtain required documentation, including discharge summaries, medication lists, and follow-up care instructions.
Monitor residents’ condition and progress during discharge planning and address concerns or complications as needed.
Collaborate with the Director of Nursing and healthcare team to support compliance with regulatory requirements and facility policies.
Participate in team meetings to discuss discharge plans, resident progress, and barriers to discharge.
Perform other duties assigned by the Director of Nursing.
Maintain regular attendance and timeliness according to the designated work schedule.