Social Worker / Discharge Planner

The Social Worker/Discharge Planner will assess the client, identify what services are needed, coordinate referrals and follow-up to ensure the client’s needs continue to be met. Problem-solving skills: Many clients will be in complex situations and have hired Senior Care Network to assist with their problems.

Responsibilities/Qualifications:

Senior Care Network is a comprehensive senior care management organization providing extensive services to senior’s and their families.  The Social Worker/Discharge Planner will assess the client, identify what services are needed, coordinate referrals and follow-up to ensure the client’s needs continue to be met. In this roll you will also assist and perform social work and discharge planning responsibilities for residents. Experience working with the elderly is a requirement.

 

Responsibilities:

• Provide supportive services to Senior’s and their families/caregivers
• Attend court hearings, and assist in filing guardianships and conservatorships
• Conduct a thorough assessment of the client and their living situation – determine the need for therapeutic, medical, psycho-social and psychiatric evaluations
• Obtain required information from PCP or other providers (prescriptions, home health care orders, medical records, therapist notes etc…)
• Send referrals to appropriate agencies (private duty, DME, home health care, etc..) to coordinate needs
• Follow up with client to ensure referrals went as planned
• Identify the need for an alternative living situation
• Coordinate a transition to senior housing (independent living, assisted living or nursing home)
• Identify any financial barriers and assist with connecting client with programs that may assist (Medicaid, VA, AAA)
• Continue to act as an ongoing care manager as their needs change
• Meet budget by monitoring expenses and implementing cost-saving actions
• Improves treatment results by studying, evaluating and re-designing processes, implementing changes and rewriting policies and procedures.
• Prepare reports by collecting, analyzing and summarizing treatment and results
• Maintain clients records and a record of communication with the client (when applicable)
• Remain up-to-date regarding local resources, programs and facilities. This may include updating Team Desk, visiting facilities and programs and attending multi-disciplinary/networking meetings.
• Other duties may be assigned as needed

Requirements

• Bachelors Degree (social work preferred)
• Minimum 1 year working with the Senior population
• Communication Skills: Care managers will speak with clients and understand their needs. They will need to speak with others on the clients behalf and act as an advocate for them.  It is crucial to have good listening skills and to be a good communicator.
• Compassion: Care managers will often work with individuals going through a difficult transition. Compassion is necessary in these situations.
• Time-Management and Organizational skills: Care Managers have multiple clients with various needs. There is a lot of paperwork to be completed and care managers will be working with several other professionals.  Being organized and efficient with your time is crucial.
• Problem-solving skills: Many clients will be in complex situations and have hired Senior Care Network to assist with their problems. Care managers will need to think clearly and critically about each client and their specific situation to find the best solution. 
• Position will involve traveling throughout the metro detroit area.

Benefits

• Full Insurance package, Medical, Dental, Vision and Prescription coverage
• Paid Time Off 
• Employee recognition events