About The Position

As the Social Worker/Discharge Planning Coordinator, you will offer supportive intervention to patients and caregivers and coordinate and facilitate the development of a discharge plan of care for high-risk patients. You will assess psychosocial risk factors for patients and caregivers and provide emotional, social, and financial support by connecting them to community resources. You will serve as a patient advocate during hospitalization, ensure continuity of care, and address psychosocial concerns such as substance abuse, mental health, and guardianships.

Requirements

  • BSW or higher degree; will consider a limited license SW on individual basis.
  • Knowledge of regulations, requirements, and community resources.
  • Ability to function effectively in a critical care environment.
  • Written and verbal skills are essential.
  • Ability to establish priorities and communicate and respond to inquiries.
  • Excellent interpersonal communication and negotiation skills.
  • Critical thinking and problem-solving skills.
  • Customer service skills.
  • Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded, and adaptable to change.
  • Effective organizational skills.
  • Computer proficiency with Outlook e-mail and electronic medical records.
  • Flexible in a complex and changing healthcare environment.
  • Understanding of pre-acute and post-acute venues of care and post-acute community resources.
  • Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources.
  • L.S.W - Licensed Social Worker

Nice To Haves

  • MSW
  • Applicable experience in patient advocacy, care management, and knowledge of hospital and community resources.
  • Previous case management or discharge planning experience.
  • Specialty certification in care management (CCM, ACM, or similar).

Responsibilities

  • Offer supportive intervention to patients and caregivers.
  • Coordinate and facilitate the development of a discharge plan of care for high-risk patients.
  • Assess psychosocial risk factors for patients and caregivers.
  • Provide emotional, social, and financial support by connecting them to community resources.
  • Serve as a patient advocate during hospitalization.
  • Ensure continuity of care.
  • Address psychosocial concerns such as substance abuse, mental health, and guardianships.

Benefits

  • Flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being.
© 2026 Teal Labs, Inc
Privacy PolicyTerms of Service