Wellstar Health System
Care Coordinator - Social Worker - located in LaGrange GA
Wellstar Health System, Lagrange, Georgia, United States, 30241
Care Coordinator – Social Worker (LaGrange, GA)
Join the team at Wellstar Health System in LaGrange, GA. Our mission is to enhance the health and well-being of every person we serve through compassion, excellence, and respect for diverse voices.
Work Shift Day (United States of America)
Job Summary The Care Coordination Social Worker (CC SW) assesses transitional care needs, coordinates care across the continuum, and engages patients and families to ensure care needs are met. The CC SW serves as a key resource for patients, consults with care team members on psychosocial and resource needs, and collaborates on timely, safe patient discharge plans.
Specific Functions
Provide psychosocial assessments and advance the discharge plan.
Relay information about community-based services (e.g., indigent care referrals, specialty care or post‑acute placements, elder assistance).
Serve as a specialist on psychosocial and discharge needs, end‑of‑life planning, and resource information.
Partner with RN case managers on complex social determinants of health and social needs.
Perform any other duties assigned.
Disposition Planning
Implements discharge planning and provides timely resource information.
Identifies and documents barriers to timely disposition.
Understands eligibility for private and public local, state, and federal resources.
Responds to referrals from RN care coordinators, physicians, and the care team.
Participates in interdisciplinary rounds to confirm discharge estimates and recommendations.
Initiates/post‑acute referrals through departmental processes.
Provides financial needs assessment for patients requiring assistance.
Advocates and partners with patients and families for autonomous decision‑making.
Respects cultural or religious beliefs in service provision.
Contributes to protocol, procedure, and performance‑improvement development.
Assessment
Initiates psychosocial risk assessments upon patient screening.
Collaborates with PAS, financial counselors, and UM nurses to assess insurance and coverage requirements.
Works with patient, family, physician, and care team to establish and support discharge plans.
Documentation
Completes initial psychosocial/functional assessment in the medical record.
Ensures updates and clear, concise documentation.
Records progress notes and patient/family interactions on time.
Documents all services delivered in the Electronic Health Record.
Tracks avoidable days and reports trends.
Professional Development and Initiative
Completes all required competency assessments and mandatory education.
Supports department‑based goals contributing to organizational success.
Acts as a preceptor or mentor for social work students when appropriate.
Required Minimum Education
Bachelor’s or Master’s degree in Social Work (Master’s strongly preferred).
Required Minimum Licenses & Certifications
BLS – Basic Life Support or BLS‑I – Basic Life Support – Instructor.
Required Minimum Experience
Minimum one year in acute‑care or related healthcare settings, or community or educational internship in care coordination.
Background in medical social work in an acute‑care setting preferred.
Required Minimum Skills
Excellent written and verbal communication.
Maturity, self‑confidence, objectivity, and positive attitude.
Self‑directed, functioning well under stress, change, and fast‑paced environments.
Strong assessment, interview, organizational, and problem‑solving skills.
Knowledge of local, state, and federal regulations.
Knowledge of community and statewide resources and programs.
Ability to collaborate with physicians, care team, and patient/family.
Join us to discover the support needed for meaningful work and a more rewarding life. Connect with Georgia’s most integrated health system and start a future that offers more.
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industry Hospitals and Health Care
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Work Shift Day (United States of America)
Job Summary The Care Coordination Social Worker (CC SW) assesses transitional care needs, coordinates care across the continuum, and engages patients and families to ensure care needs are met. The CC SW serves as a key resource for patients, consults with care team members on psychosocial and resource needs, and collaborates on timely, safe patient discharge plans.
Specific Functions
Provide psychosocial assessments and advance the discharge plan.
Relay information about community-based services (e.g., indigent care referrals, specialty care or post‑acute placements, elder assistance).
Serve as a specialist on psychosocial and discharge needs, end‑of‑life planning, and resource information.
Partner with RN case managers on complex social determinants of health and social needs.
Perform any other duties assigned.
Disposition Planning
Implements discharge planning and provides timely resource information.
Identifies and documents barriers to timely disposition.
Understands eligibility for private and public local, state, and federal resources.
Responds to referrals from RN care coordinators, physicians, and the care team.
Participates in interdisciplinary rounds to confirm discharge estimates and recommendations.
Initiates/post‑acute referrals through departmental processes.
Provides financial needs assessment for patients requiring assistance.
Advocates and partners with patients and families for autonomous decision‑making.
Respects cultural or religious beliefs in service provision.
Contributes to protocol, procedure, and performance‑improvement development.
Assessment
Initiates psychosocial risk assessments upon patient screening.
Collaborates with PAS, financial counselors, and UM nurses to assess insurance and coverage requirements.
Works with patient, family, physician, and care team to establish and support discharge plans.
Documentation
Completes initial psychosocial/functional assessment in the medical record.
Ensures updates and clear, concise documentation.
Records progress notes and patient/family interactions on time.
Documents all services delivered in the Electronic Health Record.
Tracks avoidable days and reports trends.
Professional Development and Initiative
Completes all required competency assessments and mandatory education.
Supports department‑based goals contributing to organizational success.
Acts as a preceptor or mentor for social work students when appropriate.
Required Minimum Education
Bachelor’s or Master’s degree in Social Work (Master’s strongly preferred).
Required Minimum Licenses & Certifications
BLS – Basic Life Support or BLS‑I – Basic Life Support – Instructor.
Required Minimum Experience
Minimum one year in acute‑care or related healthcare settings, or community or educational internship in care coordination.
Background in medical social work in an acute‑care setting preferred.
Required Minimum Skills
Excellent written and verbal communication.
Maturity, self‑confidence, objectivity, and positive attitude.
Self‑directed, functioning well under stress, change, and fast‑paced environments.
Strong assessment, interview, organizational, and problem‑solving skills.
Knowledge of local, state, and federal regulations.
Knowledge of community and statewide resources and programs.
Ability to collaborate with physicians, care team, and patient/family.
Join us to discover the support needed for meaningful work and a more rewarding life. Connect with Georgia’s most integrated health system and start a future that offers more.
Seniority Level Entry level
Employment Type Full‑time
Job Function Other
Industry Hospitals and Health Care
#J-18808-Ljbffr