Social Services/Discharge Planner

Nampa of Cascadia, LLC•Nampa, ID

About The Position

The Social Services/Discharge Planner advocates for residents, protects vulnerable residents, and works to ensure their best interests are observed while helping them find remedies for their situations. The role also monitors and completes the steps of residents’ discharges. The planner assesses patients’ psychosocial status in relation to their illness and environment, communicates findings to the registered nurse, and supports person-centered care and successful discharge planning in collaboration with residents, families, physicians, facility staff, and community agencies. All Cascadia Healthcare employees must submit to and be cleared under the applicable state background check requirements before having contact with patients or residents.

Requirements

Demonstrated verbal and written communication skills and organizational skills.
Must have a valid driver’s license.

Nice To Haves

LCSW, LSW, or MSW license preferred.
Experience in post-acute or skilled nursing preferred.

Responsibilities

Assess patients’ psychosocial status in relation to their illness and environment and communicate findings to the registered nurse.
Work with families, patients, physicians, and staff on discharge planning to ensure documentation and orders are in place and patients have what they need for a successful discharge.
Participate actively in discharge planning and advise on residents’ or patients’ practical and environmental needs after discharge.
Conduct social evaluations and plan person-centered interventions based on evaluation findings.
Maintain clinical documentation for all patients referred to social work.
Provide information and coordinate referral services for residents or patients and their families or caregivers regarding practical and environmental needs.
Inform residents or patients and their families or caregivers about community agencies and other available services.
Serve as a liaison between residents or patients, their families or caregivers, and community agencies.
Maintain collaborative relationships with facility coworkers to support resident or patient care.
Participate in developing the total plan of care and in case conferences for residents or patients referred to social services, as required.
Help physicians and other team members understand significant social and emotional factors related to residents’ or patients’ health problems.
Address resident behaviors to prevent harm to residents themselves or others.
Coordinate medication regimen reviews to determine gradual dose reduction to the lowest possible dose.
Monitor and complete the steps of residents’ discharges.
Submit to and obtain clearance under applicable state background check requirements before contact with patients or residents.