Medical social worker jobs in Hillsboro, OR - 92 jobs

Job Posting: Community Medical Social Worker (MSW) Compensation: Starting salary $90,000 annually Employment Type: Full-Time Reports To: Director of Clinical Services / Administrator Job Description VistaRiver Hospice and Physicians Choice Home Health are excited to announce a vacancy for a dedicated and experienced Community Medical Social Worker (MSW) in the State of Oregon. This crucial role demands a hands-on professional committed to delivering superior care within homes and communities, catering to patients faced with life-limiting illnesses and their families. This position is ideal for individuals seeking a robust, full-time opportunity to impact lives positively while working closely with an interdisciplinary team of healthcare professionals. It's important to note that this is not a remote job, requiring regular travel within assigned service areas of Oregon. The MSW will be instrumental in providing comprehensive psychosocial support, addressing emotional, mental, and social needs, and helping clients navigate their healthcare journey through carefully coordinated resources and counseling. If you are looking to make a significant impact in the hospice care sphere, we invite you to consider this rewarding career pathway with us. Duties and Responsibilities Conduct comprehensive psychosocial assessments for patients and families in home and community settings. Assess and address emotional and mental health needs, social determinants of health, caregiver stress, family dynamics, safety, housing, and financial concerns. Provide counseling, education, and supportive interventions aligned with patient goals of care. Facilitate advance care planning, patient advocacy, and informed decision-making. Coordinate and connect patients and families with community resources, benefits, and support services. Provide psychosocial support to patients with terminal or life-limiting illness and their caregivers. Address anticipatory grief, loss, and emotional adjustment throughout the hospice episode. Participate in Interdisciplinary Group (IDG) meetings in accordance with 42 CFR §418.56. Support and coordinate bereavement services per VistaRiver Hospice policy. Complete timely, accurate, and CMS-compliant documentation in the electronic medical record. Maintain strict compliance with HIPAA and Oregon privacy laws. Requirements Master's Degree in Social Work (MSW) from a CSWE-accredited program. Current, active, and unrestricted Oregon social work license (LMSW or LCSW); license must remain in good standing with the Oregon Board of Licensed Social Workers. Valid Oregon driver's license, reliable transportation, and current auto insurance. Minimum 2 years of healthcare or community-based social work experience. Experience in hospice, home health, or serious illness care strongly preferred. Demonstrated knowledge of Oregon Administrative Rules (OAR) applicable to hospice services and CMS Conditions of Participation for hospice (42 CFR Part 418). Experience working with interdisciplinary teams (IDG) and community partners. Strong communication, crisis-management, and interpersonal skills. Ability to work independently in the field while maintaining close collaboration with the care team. Strong organizational skills with the ability to manage a community-based caseload. Cultural humility and respect for patient autonomy, dignity, and diversity. Ability to travel throughout assigned Oregon service areas. Capacity to function effectively in emotionally sensitive and end-of-life environments.

--------------------------------------------------------------- NOTE: This is a PRN role that will work 100% in the community and support the Portland Metro area. Candidates will need to have 5 weekdays of availability per month. The Hospice Social Worker is responsible for delivery of social work services to hospice patients, including psychosocial evaluations, ongoing counseling, casework services, coordination of referrals and bereavement services. Estimated Hiring Range: $43.38 - $53.02 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities * Performs initial and ongoing psychosocial/bereavement evaluations of patients/family/caregiver and assists in the development/implementation of the plan of care. * Is a core member of the interdisciplinary group (IDG) and actively participates in IDG meetings for development and evaluation of the patient's plan of care. * Implements a plan of care for each assigned patient/family/caregiver unit and evaluation of that plan of care. * Assists patient/family/caregiver in determining of goals of care including completion of Advance Directives and POLST forms as needed. * Conducts patient and family counseling and education considering family system/dynamics and coping methods to all age groups. * Addresses advocacy needs for patients/families/and organization. * Facilitates formal and informal meetings with patients/caregivers/family member as needed. * Provides crisis management support and consultations with patient/family/caregiver or IDG team. * Provides information regarding the patient/family/caregivers psychosocial, spiritual, physical and financial needs or difficulties to the IDG team or providers involved in the patients care. * Serves as liaison with hospitals, care facilities and appropriate agencies to promote interagency cooperation, developing and maintaining communication and facilitating referrals to meet patient needs throughout the continuum of care. * Responsible for organizing/facilitating the transfer/discharge of patients. * Assists the family/caregivers in making final arrangements at time of patient's death. * Assesses, develops and coordinates bereavement plan for significant others for one year following patient death. * Responsible for documentation in the electronic medical records, assuring accuracy, completeness and compliance with regulations, certification standards, legal and ethical standards according to policies and procedures. * Participate in orientation of new employees, volunteers or students seeking experience in hospice. Organizational Responsibilities * Perform work in alignment with the organization's mission, vision and values. * Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. * Strive to meet annual business goals in support of the organization's strategic goals. * Adhere to the organization's policies, procedures and other relevant compliance needs. * Perform other duties as needed. Experience and/or Education Required * Master's degree in social work from an accredited college * Current Oregon LCSW, LMSW or CSWA license * Minimum one year hospice experience, including a background in medical social work * Valid driver's license, acceptable driving record, and automobile liability coverage or access to an insured vehicle * CPR certification at hire or within 6 months in position Knowledge, Skills and Abilities Required Knowledge * Knowledge in case management, social work and counseling in a hospice setting * Knowledge of Federal, State and Local regulations, Hospice Medicare Conditions of Participation, and HIPAA privacy rules and regulations Skills and Abilities * Practice within the scope of license, certification or registration, where applicable, and as required by law and regulation * Excellent interpersonal skills * Ability to work both independently and collaboratively * Ability to work under pressure to meet deadlines * Ability to take initiative and utilize innovative techniques and ingenuity * Ability to interact with various departments throughout the organization * Ability to work flexible hours (i.e., after-hours coverage or weekend coverage), as needed * Ability to plan, prioritize and coordinate multiple projects or tasks * Must have general computer skills and a working knowledge of Electronic Medical Records systems, MS office, Outlook, and the internet * Ability to adhere to organizational standards, policies, and procedures * Ability to tolerate grief * Ability to work effectively with diverse individuals and groups * Ability to learn, focus, understand, and evaluate information and determine appropriate actions * Ability to accept direction and feedback, as well as tolerate and manage stress * Ability to see, read, hear, and speak clearly for at least 6 hours/day * Ability to push, pull, stand, sit, and perform repetitive finger and wrist movement for at least 3-6 hours/day * Ability to lift, carry, walk, bend, climb stairs and/or pinch small objects up to 3 hours/day * Ability to operate a motor vehicle in all kinds of weather conditions Working Conditions Work Environment(s): ☒ Indoor/Office ☒ Community ☐ Facilities/Security ☒ Outdoor Exposure Member/Patient Facing: ☐ No ☒ Telephonic ☒ In Person Hazards: May include, but not limited to, physical, ergonomic, and biological hazards. Equipment: General office equipment Travel: Requires travel outside of the workplace at least weekly; the employee's personal vehicle may be used. Driving infractions will be monitored in accordance with organizational policy. (frequent/weekly drivers only) Work Location: Member/Patient Facing Setting Schedule: This position may occasionally require more than 8 hours per day. If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws. If you receive an offer of employment for this position, it is contingent on the satisfactory completion of a pre-employment background check, immunization review, and drug screen (including THC/Marijuana). CareOregon is a federal contractor and must comply with all federal laws. We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. Housecall Providers offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer Housecall Providers is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.

Why Suncrest We are seeking an MSW to join our team! At Brighton/Suncrest Hospice our goal is to change the expectation of hospice care in your area by providing exceptional care and service to our patients. This is achieved by allocating the resources to increase our staff to patient ratios, thereby increasing clinical visits while lowering clinician caseloads. We are proud to be a Community Health Accreditation Partner (CHAP) certified hospice. If you have a commitment to providing the highest quality of care to patients and their families, we would like to hear from you! Benefits Actual Work/Life Balance Competitive Pay Benefits Package including Medical, Dental, and Vision insurance Paid Time Off 401k plan with employer match and 100% vesting after 90 days of employment A culture with an emphasis on appreciating and valuing the team member The opportunity to be part of a rapidly growing national company, with possible position upgrades Details The Social Worker assists patients and families in coping with problems resulting from severe or long-term illness. They will assess, diagnose, and treat patient's mental and social conditions, counsel individuals and/or families, and update case records. Qualifications Assesses psychosocial status of client and social and emotional factors related to the client's illness, need for care, and response to treatment. Provides direct social casework services to clients and families including assisting with goal setting, counseling, and planning and providing interventions. Advises agency personnel, clients, and families of appropriate community resources, their eligibility criteria, and regulations. Participates in the development and periodic renewal of the client's plan of care. Observes and reports to the physician, the response of the client to treatment and changes in his condition. Maintains verbal and/or written communication with other personnel involved with care of the client. Maintains appropriate and timely client care records including observations, treatments, client response to treatment, and changes in client's condition. Attends and participates in appropriate client care conferences, staff meetings, and agency committee meetings. Thorough knowledge of social work principles and methods. Knowledge of individuals and group behavior and ways of working effectively with adults, children, and families who have social, economic, emotional, or health problems. Ability to exercise independent professional judgment in complex situations. Ability to establish and maintain effective working relationships with clients and families, staff members, outside agencies and institutions, and the general public. Ability to communicate effectively both orally and in writing. Master's degree in Social Work required

A Social Worker provides support and resources to individuals and families facing social, emotional, and health-related challenges. Responsibilities include assessing client needs, developing care plans, connecting individuals to community services, and advocating for their well-being. Apply for specific facility details.

MedSource Travelers offers assignments nationwide and is currently seeking a qualified Social Worker Medical Social Worker with 1-2 year's experience for a travel assignment in Portland, Oregon. Please have resume, skills checklist and 2-3 references within the last 12 months. Contact us today about job details. The benefits of MedSource Travelers include, Weekly Pay Holiday Pay Continuing Education Referral Bonus Medical Benefits Dental Benefits Vision Benefits Let's get started!

**Become a part of our caring community and help us put health first** The **Medical Social Worker** participates in the interdisciplinary care provided to home health patients. The Medical Social Worker functions to evaluate and develop a plan of care personalized to fit the patient's emotional and social needs. The Medical Social Worker provides direction and supervision of the Social Worker Assistant as required and when involved in the patient's plan of care. The Medical Social Worker works within CenterWell Home Health's company-specific policy and procedures, applicable healthcare standards, governmental laws, and regulations. + Assesses the patient's social and emotional state as it relates to his or her illness or injury, needs for care and his or her response to such treatment, and adjustments to care. + Assesses any relationships of the patient's medical and nursing needs in the home setting, financial resources, and available community resources. + Provides any appropriate action to obtain available community resources to assist in resolving issues that may be impeding the patient's recovery. + Instructs patients and families in treating and coping with social and emotional response connected with Provides ongoing assessment of patient and family needs and responses to teaching + Assists the physician and other health team members in understanding the significant social and emotional factors related to the patient's health Participates in the development and periodic re-evaluation of the physician's Plan of Care for the patient. + Observes, records, and reports changes in patients' condition and response to treatment to the Clinical Manager and the Participates in the discharge planning process + Participates as a member of the interdisciplinary care team in care coordination activities and acts as a resource to other health team members in the identification and resolution of patient needs + Supervises instructs and evaluates the performance of the Social Work Assistant (BSW) to assure that all medical social services are provided to patients in compliance with Company, government, and professional standards + Maintains and submits documentation as required by the company and/ or facility including any case conferences, patient/physician community contacts, visit reports progress notes, and confers with other health care disciplines in providing optimum patient. **Use your skills to make an impact** **Required Skills/Experience** + Masters or doctoral degree from a school of social work accredited by the Council on Social Work Education. + Social Worker licensure in the state of practice; if required by state law or regulation. + A valid driver's license, auto insurance, and reliable transportation are required. + Proof of current CPR certification + Minimum of one year of experience as a social worker in a health care setting, home health, and/or hospice. + Knowledge of and the ability to assist with discharge planning needs, and to obtain community resources (housing, shelter, funeral/memorial service arrangements, legal, information and referral, state/federal financial and medication programs, and eligibility. + Excellent oral and written communication and interpersonal skills. + Must read, write and speak fluent English. + Knowledge of medications and their correct administration. + Ability to organize tasks, develop action plans, set priorities, and function under stressful situations. + Ability to be flexible in work hours and travel locally. + Ability to communicate effectively with patients and their family members and at all levels of the organization. + Maintains current licensure certifications and meets mandatory continuing education requirements. + Must read, write and speak fluent English. + Must have good and regular attendance. + Performs other related duties as assigned. + Valid driver's license, auto insurance and reliable transportation. **Scheduled Weekly Hours** 24 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About Us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

The Pediatric Palliative Care Social Worker provides a professional continuum of services to address the psychosocial needs of patients and families affected by serious and life-limiting illnesses in order to ensure the highest possible quality of care and comfort. The social worker is a member of the Palliative Care Consultation Service and completes psychosocial assessments, provides counseling, participates in treatment planning, and provides resource referrals. Further, the social worker partners with unit social workers and case managers regarding transitional care and discharge planning needs. The social worker is an identified expert in palliative care issues and provides consultation and educational programming to OHSU staff and the community. As part of the position, the social worker will actively participate in telemedicine efforts to increase the competency of rural care providers in the area of palliative care. The Medical Social Worker is expected to practice in accordance with performance standards, core values and with a commitment to service excellence. May provide social work services to patients in Adult, Pediatric services and/or in the Emergency Department and on some rare occasions, complete home visits. Function/Duties of Position * Conducts culturally competent psychosocial evaluations of patients and families to address their adjustment to illness and care planning needs. * Provides grief and loss counseling and education to patients and families. * Provides advocacy to patients and families in a manner that supports a family centered care philosophy in which there are four guiding principles: 1. Dignity and respect (listening to and honoring parental beliefs and choices) 2. Information sharing (the right to receive timely, complete and accurate information in order to participate effectively in care and decision-making) 3. Participation (encouraging and supporting parental participation in care) and 4. Collaboration (incuding patients and families in the evaluation and development of hospital policies and program, as well as in the delivery of patient care * Assess patient and family support needs and make appropriate referrals. * Provides crisis intervention and supportive counseling in response to the mental health needs of patients and families. Counseling may include short-term therapeutic interventions, development and facilitation of support groups, and family systems work. * Other Duties as Assigned Required Qualifications * A Master's Social Work (MSW) required. * Medical social work experience * Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required for employees who practice clinical social work. * Able to implement assessments, short term counseling, crisis intervention, advocacy. * Excellent task prioritization, time management, and communication skills. Preferred Qualifications * Health care experience preferred. * 1 year of medical social work experience * 1 year of palliative care and/or hospice experience. Additional Details Posted: 12/17/2025 3:06pm Requires prioritization. Frequent interruptions in an evironment of frequent change and fluctuations. For inpatient units accepts accountability and responsibility. May be exposed to body fluids, tissue, possible radiation exposure, and infectious processes. Subject to computer work for several hours, as needed. Able to utilize office equipment within work area. Benefits: * Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee * Two separate above market pension plans to choose from * Vacation- up to 200 hours per year depending on length of service * Sick Leave- up to 96 hours per year * 8 paid holidays per year * Substantial Tri-met and C-Tran discounts * Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP) All are welcome Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at ************ or *************.

The Float Medical Social Worker, as a member of a multi-disciplinary team, has the primary responsibility for assessment, counseling, care coordination, information/referral, crisis intervention, patient advocacy and associated services to patients, families, significant others and involved parties/agencies. The efforts are directed at assisting in the patient/family adjustment to illness, injury or disability and secondary adjustment to hospitalization or other treatment, and readjustment to the community. The Department has corresponding teaching and research functions related to health and healthcare delivery practices. The Medical Social Worker provides direct intervention on an as-needed basis with infants, children, adolescents, adults and elderly patients and/or families. The Float Medical Social Worker is expected to practice in accordance with performance standards, core values and with a commitment to service excellence. Primary role is to provide services to pediatric patients and their families, but may provide social work services to patients in Adult units, Peds unit and/or ED as needed. Function/Duties of Position Conducts psychosocial evaluations of patients/families and significant others including, but not limited to the following: adjustment to medical or health condition; care coordination; mental health status; adjustment/compliance to treatment process; substance usage; child and elder abuse/neglect assessments; domestic violence issues; cognitive status (including potential guardian issues); and patient/family resources. Provides crisis intervention and supportive short term counseling to patients/families and significant others as necessary to meet immediate psycho-social needs including, but not limited to: Trauma/Emergency Department/ On Call/ Family Notification, CODE Response (family intervention); unanticipated change in health conditions/suicidal ideation; teenage pregnancy; single parent pregnancy/parenthood, domestic violence, child and elder abuse/neglect. Provides grief/loss counseling and education regarding: fetal demise; actual/pending death of patient//family member; complicated pregnancies; postpartum depression; chronic/acute stress associated with life circumstances; divorce/separation; loss of independence associated with illness or disability. Provides brief psychotherapy including: individual short term psychotherapy; group work including information/ support groups, family support, patient therapy); regarding but not limited to issues of adoption, abortion , domestic violence, family of origin, sexual/gender, substance abuse, parenting, relationship adjustment to disabilities and chronic or acute illness. Assess patient/family support needs regarding: transportation, housing, clothing and educational/patient vocational rehabilitation and training materials and refer to appropriate resources. Required Qualifications A Master's Social Work (MSW) required. Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required for employees who practice clinical social work. Preferred Qualifications Health care experience preferred. 1 year experience in a primary care clinic setting. 1 year hospital experience. Additional Details Requires prioritization.. Frequent interruptions in an evironment of frequent change and fluctuations. For inpatient units accepts accountability and responsibility. May be exposed to body fluids, tissue, possible radiation exposure, and infectious processes. Subject to computer work for several hours, as needed. Able to utilize office equipment within work area. Posted: 12/30/2025 11:56am All are welcome Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at ************ or *************.

(1) Duties of Social Workers (a) Provide psychiatric Social Work services, to patients and their families, as a member of an Interdisciplinary Treatment Team. (b) Services include, but are not limited to conducting of Psychosocial Assessments,treatment planning, group and individual intervention including case coordination and documentation. Case coordination in support of a patient's community integration will include linking patients to community resources, establishing insurance and other benefits, and liaising with various legal and mental health systems. (c) Throughout the provision of Social Work services, the Social Worker adheres to social work values and ethics as outlined by the Oregon State Board of Clinical Social Workers. (d) Conduct Psychosocial Assessment: Psychosocial history gathering and assessment of information from patients, families, community mental health programs, other collateral informants. (e) Participation with the treatment team in establishing Treatment and Care Plans, implementation of those treatment plans. (f) Effective liaison with community mental health agencies, Senior and People with Disabilities Division, Veteran's Administration, potential providers, public and private hospitals, legal entities, substance abuse treatment programs and other socia service agencies. (g) Conducts individual and group treatment as well as family counseling and education. Package Details

About the Role: The PRN Home Health Social Worker plays a critical role in supporting patients and their families within the home health care setting across the United States. This position focuses on assessing psychosocial needs, providing counseling, and connecting patients to community resources to enhance their overall well-being and quality of life. The social worker collaborates closely with interdisciplinary teams, including nurses and therapists, to develop and implement individualized care plans that address both medical and social determinants of health. By offering crisis intervention, advocacy, and education, the social worker helps patients navigate complex healthcare systems and overcome barriers to care. Ultimately, this role ensures that patients receive comprehensive support that promotes independence and successful health outcomes in their home environments. Minimum Qualifications: Master's degree in Social Work (MSW) from an accredited program. Current and valid state licensure as a Licensed Clinical Social Worker (LCSW) or equivalent. Experience in home health, hospice, or community-based social work settings. Strong knowledge of psychosocial assessment techniques and care planning. Ability to work independently and manage a flexible schedule as a PRN (pro re nata) employee. Preferred Qualifications: Experience working with diverse patient populations, including elderly and chronically ill individuals. Familiarity with Medicare, Medicaid, and other healthcare reimbursement systems. Certification in hospice and palliative care social work. Experience working in home health care Proficiency in electronic medical record (EMR) systems. Bilingual skills or cultural competency training. Responsibilities: Conduct comprehensive psychosocial assessments of patients and their families to identify needs, strengths, and potential barriers to care. Develop and implement individualized care plans in collaboration with the interdisciplinary home health team. Provide counseling and emotional support to patients and caregivers, addressing issues such as coping with illness, grief, and family dynamics. Coordinate referrals to community resources, support services, and financial assistance programs to enhance patient care. Advocate for patient rights and needs within the healthcare system and community settings. Document all patient interactions, assessments, and interventions accurately and timely in compliance with regulatory standards. Participate in team meetings and communicate effectively with healthcare professionals to ensure continuity of care. Respond to crisis situations promptly, providing intervention and support as needed. Skills: The required skills enable the social worker to perform thorough psychosocial assessments and develop effective care plans tailored to each patient's unique circumstances. Strong communication and counseling skills are essential for providing emotional support and facilitating patient and family education. Organizational and documentation skills ensure compliance with healthcare regulations and accurate record-keeping. Preferred skills such as familiarity with healthcare reimbursement and EMR systems streamline coordination with interdisciplinary teams and administrative processes. Cultural competency and bilingual abilities enhance the social worker's capacity to engage with diverse populations, ensuring equitable and sensitive care delivery.

Job Description Social Services Coordinator Status: Full-Time, Day Shift, Monday - Friday Apply at Teamavamere.com Job Summary The Social Services Coordinator works under the supervision of the Social Services Director and in accordance with current federal, state, and local standards, guidelines, and regulations, as well as Avamere's established policies and procedures, to ensure that the medically related emotional, mental, and psychosocial needs of the residents are met. Additionally, the Social Services Coordinator acts as a liaison between the resident/family and community partners, providers, and payors to ensure safe discharge planning and continuation of care. Essential Duties and Job Responsibilities Identifies residents' emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date Works with the Social Services Director and interdisciplinary team to identify discharge plans, barriers, and needs to effectively coordinate a safe discharge from the facility Communicates with residents, families, community providers and programs, and any other parties, on a consistent and timely basis Acts as the resident advocate by ensuring that their resident rights are upheld and that all parties are acting in the best interest of the resident Coordinates with community support services such as home health, hospice, and durable medical services to ensure that residents have the supports and services they need post-discharge Arranges for provision of ancillary services for residents while they are in the facility including transportation to/from ancillary appointments Coordinates and conducts regular care conferences with residents and families as well as other meetings as needed Monitors residents' mood and behaviors, creates behavioral care plans as appropriate, and assists residents in seeking mental health supports and services if needed Works with insurance companies and other payors to ensure payment for skilled nursing and/or long-term care services and issues non-coverage notices on behalf of Medicare and insurance companies Assists residents and families in applying for Medicaid services, including spend downs Assists residents and families in finding appropriate placement in outside facilities following discharge from Avamere facilities Acts as the point person and record keeper for grievance and lost items Assists residents in obtaining clothing and other personal items as needed Participates in facility quality assurance program and other meetings as required Performs other duties as assigned Requirements and Qualifications Prefer bachelor's degree in public health administration, social work or a related field Prefer experience working with electronic medical records and computer documentation systems 1 year of experience in a skilled nursing facility or similar health care setting preferred At Avamere, we believe in taking care of our employees. We offer a comprehensive benefits package that includes: Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible. 401 (k) Plan: After 90 days of employment, with matching program. Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave. EAP Canopy with unlimited telehealth mental health visits. Continuing Education and Higher Education Reimbursement. Generous employee referral bonus program. Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account). Professional Development: Opportunities for growth and development within the company. Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more. Avamere is an Equal Opportunity Employer and participates in E-Verify.

Social Services Coordinator Status: Full-Time, Day Shift, Monday - Friday Apply at Teamavamere.com The Social Services Coordinator works under the supervision of the Social Services Director and in accordance with current federal, state, and local standards, guidelines, and regulations, as well as Avamere's established policies and procedures, to ensure that the medically related emotional, mental, and psychosocial needs of the residents are met. Additionally, the Social Services Coordinator acts as a liaison between the resident/family and community partners, providers, and payors to ensure safe discharge planning and continuation of care. Essential Duties and Job Responsibilities Identifies residents' emotional, mental, and psychosocial needs and ensures that comprehensive care plans are in place and up to date Works with the Social Services Director and interdisciplinary team to identify discharge plans, barriers, and needs to effectively coordinate a safe discharge from the facility Communicates with residents, families, community providers and programs, and any other parties, on a consistent and timely basis Acts as the resident advocate by ensuring that their resident rights are upheld and that all parties are acting in the best interest of the resident Coordinates with community support services such as home health, hospice, and durable medical services to ensure that residents have the supports and services they need post-discharge Arranges for provision of ancillary services for residents while they are in the facility including transportation to/from ancillary appointments Coordinates and conducts regular care conferences with residents and families as well as other meetings as needed Monitors residents' mood and behaviors, creates behavioral care plans as appropriate, and assists residents in seeking mental health supports and services if needed Works with insurance companies and other payors to ensure payment for skilled nursing and/or long-term care services and issues non-coverage notices on behalf of Medicare and insurance companies Assists residents and families in applying for Medicaid services, including spend downs Assists residents and families in finding appropriate placement in outside facilities following discharge from Avamere facilities Acts as the point person and record keeper for grievance and lost items Assists residents in obtaining clothing and other personal items as needed Participates in facility quality assurance program and other meetings as required Performs other duties as assigned Requirements and Qualifications Prefer bachelor's degree in public health administration, social work or a related field Prefer experience working with electronic medical records and computer documentation systems 1 year of experience in a skilled nursing facility or similar health care setting preferred At Avamere, we believe in taking care of our employees. We offer a comprehensive benefits package that includes: Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible. 401 (k) Plan: After 90 days of employment, with matching program. Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave. EAP Canopy with unlimited telehealth mental health visits. Continuing Education and Higher Education Reimbursement. Generous employee referral bonus program. Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account). Professional Development: Opportunities for growth and development within the company. Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more. Avamere is an Equal Opportunity Employer and participates in E-Verify.

Job Description Social Services Coordinator Status: Full-Time Schedule: Monday-Friday 9a-5p Apply at Teamavamere.com The Social Services Coordinator partners with the Social Services Director to coordinate the social services program in a skilled nursing center and ensure that the residents' medically related emotional and social needs are met and maintained per all applicable laws and regulations. Essential Duties and Job Responsibilities Meets with new admissions to document the resident's psychosocial history and identify the current psychosocial needs as directed by the Social Services Director. Collaborates with the Social Services Director, leadership team, the resident and/or resident's representatives, and physician to determine discharge plans. Communicates regularly with all parties regarding the plan and encourages resident and/or resident's representative participation in all planning and discharge process steps. Coordinates home health, hospice, and support services, including making referrals and obtaining services from outside agencies as needed. Arrange ancillary services, including but not limited to dental, ophthalmology, and audiology services. Coordinating appointments for such services and transportation may be required. Completes and issues Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) as applicable. Completes assigned sections on the MDS and participates in coordinating Medicaid services. Documents care plan and services provided in the resident's record per state and federal regulatory requirements and Prestige policies. Ensures that all entries are accurate, timely, and descriptive of the services provided. Acts as a resident advocate by ensuring that services are provided in the resident's best interest and educates on residents' rights. Assists residents in accessing mental health services and other community resources. Arranges and obtains needed durable medical equipment, clothing, and personal items for residents. Conducts and assists in coordinating resident and family support groups including the development of programs for special needs residents. Manages behavioral health services, including tracking, meetings, care planning, and care and services. Coordinates and updates Behavior Monitors for residents as required. Partners with the clinical team in training staff on residents' behaviors and appropriate behavioral interventions. Attends meetings such as Stand-up, Managing Acute Care Conditions (MACC), Quality Assurance Performance Improvement (QAPI), and other meetings as required. Performs other duties as assigned. Successful incumbent employees must be able to perform the position's essential duties to the organization's satisfaction, with or without a reasonable accommodation. Requirements and Qualifications Minimum Requirements: One year of experience working in skilled nursing or similar health care setting or the ability to demonstrate equivalent knowledge and skills. Associate's degree or equivalent knowledge and skills obtained through a combination of education, training, and experience. Benefits: Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible. 401 (k) Plan: After 90 days of employment, with matching program. Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave. EAP Canopy with unlimited telehealth mental health visits. Continuing Education and Higher Education Reimbursement. Generous employee referral bonus program. Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account). Professional Development: Opportunities for growth and development within the company. Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more. Avamere is an Equal Opportunity Employer and participates in E-Verify.

The Pediatric Palliative Care Social Worker provides a professional continuum of services to address the psychosocial needs of patients and families affected by serious and life-limiting illnesses in order to ensure the highest possible quality of care and comfort. The social worker is a member of the Palliative Care Consultation Service and completes psychosocial assessments, provides counseling, participates in treatment planning, and provides resource referrals. Further, the social worker partners with unit social workers and case managers regarding transitional care and discharge planning needs. The social worker is an identified expert in palliative care issues and provides consultation and educational programming to OHSU staff and the community. As part of the position, the social worker will actively participate in telemedicine efforts to increase the competency of rural care providers in the area of palliative care. The Medical Social Worker is expected to practice in accordance with performance standards, core values and with a commitment to service excellence. May provide social work services to patients in Adult, Pediatric services and/or in the Emergency Department and on some rare occasions, complete home visits. Function/Duties of Position Conducts culturally competent psychosocial evaluations of patients and families to address their adjustment to illness and care planning needs. Provides grief and loss counseling and education to patients and families. Provides advocacy to patients and families in a manner that supports a family centered care philosophy in which there are four guiding principles: 1. Dignity and respect (listening to and honoring parental beliefs and choices) 2. Information sharing (the right to receive timely, complete and accurate information in order to participate effectively in care and decision-making) 3. Participation (encouraging and supporting parental participation in care) and 4. Collaboration (incuding patients and families in the evaluation and development of hospital policies and program, as well as in the delivery of patient care Assess patient and family support needs and make appropriate referrals. Provides crisis intervention and supportive counseling in response to the mental health needs of patients and families. Counseling may include short-term therapeutic interventions, development and facilitation of support groups, and family systems work. Other Duties as Assigned Required Qualifications A Master's Social Work (MSW) required. Medical social work experience Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required for employees who practice clinical social work. Able to implement assessments, short term counseling, crisis intervention, advocacy. Excellent task prioritization, time management, and communication skills. Preferred Qualifications Health care experience preferred. 1 year of medical social work experience 1 year of palliative care and/or hospice experience. Additional Details Posted: 12/17/2025 3:06pm Requires prioritization. Frequent interruptions in an evironment of frequent change and fluctuations. For inpatient units accepts accountability and responsibility. May be exposed to body fluids, tissue, possible radiation exposure, and infectious processes. Subject to computer work for several hours, as needed. Able to utilize office equipment within work area. Benefits: Healthcare Options - Covered 100% for full-time employees and 88% for dependents, and $25K of term life insurance provided at no cost to the employee Two separate above market pension plans to choose from Vacation- up to 200 hours per year depending on length of service Sick Leave- up to 96 hours per year 8 paid holidays per year Substantial Tri-met and C-Tran discounts Additional Programs including: Tuition Reimbursement and Employee Assistance Program (EAP) All are welcome Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at ************ or *************.

The Float Medical Social Worker, as a member of a multi-disciplinary team, has the primary responsibility for assessment, counseling, care coordination, information/referral, crisis intervention, patient advocacy and associated services to patients, families, significant others and involved parties/agencies. The efforts are directed at assisting in the patient/family adjustment to illness, injury or disability and secondary adjustment to hospitalization or other treatment, and readjustment to the community. The Department has corresponding teaching and research functions related to health and healthcare delivery practices. The Medical Social Worker provides direct intervention on an as-needed basis with infants, children, adolescents, adults and elderly patients and/or families. The Float Medical Social Worker is expected to practice in accordance with performance standards, core values and with a commitment to service excellence. Primary role is to provide services to pediatric patients and their families, but may provide social work services to patients in Adult units, Peds unit and/or ED as needed. Function/Duties of Position * Conducts psychosocial evaluations of patients/families and significant others including, but not limited to the following: adjustment to medical or health condition; care coordination; mental health status; adjustment/compliance to treatment process; substance usage; child and elder abuse/neglect assessments; domestic violence issues; cognitive status (including potential guardian issues); and patient/family resources. * Provides crisis intervention and supportive short term counseling to patients/families and significant others as necessary to meet immediate psycho-social needs including, but not limited to: Trauma/Emergency Department/ On Call/ Family Notification, CODE Response (family intervention); unanticipated change in health conditions/suicidal ideation; teenage pregnancy; single parent pregnancy/parenthood, domestic violence, child and elder abuse/neglect. * Provides grief/loss counseling and education regarding: fetal demise; actual/pending death of patient//family member; complicated pregnancies; postpartum depression; chronic/acute stress associated with life circumstances; divorce/separation; loss of independence associated with illness or disability. * Provides brief psychotherapy including: individual short term psychotherapy; group work including information/ support groups, family support, patient therapy); regarding but not limited to issues of adoption, abortion , domestic violence, family of origin, sexual/gender, substance abuse, parenting, relationship adjustment to disabilities and chronic or acute illness. * Assess patient/family support needs regarding: transportation, housing, clothing and educational/patient vocational rehabilitation and training materials and refer to appropriate resources. Required Qualifications * A Master's Social Work (MSW) required. * Certificate of Clinical Social Work Associate (CSWA) or Licensed Clinical Social Worker (LCSW) required for employees who practice clinical social work. Preferred Qualifications * Health care experience preferred. * 1 year experience in a primary care clinic setting. * 1 year hospital experience. Additional Details Requires prioritization.. Frequent interruptions in an evironment of frequent change and fluctuations. For inpatient units accepts accountability and responsibility. May be exposed to body fluids, tissue, possible radiation exposure, and infectious processes. Subject to computer work for several hours, as needed. Able to utilize office equipment within work area. Posted: 12/30/2025 11:56am All are welcome Oregon Health & Science University values a diverse and culturally competent workforce. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are encouraged to apply. To request reasonable accommodation contact the Affirmative Action and Equal Opportunity Department at ************ or *************.

**Become a part of our caring community and help us put health first** The Medical Social Worker participates in the interdisciplinary care provided to home health patients. The Medical Social Worker functions to evaluate and develop a plan of care personalized to fit the patient's emotional and social needs. The Medical Social Worker provides direction and supervision of the Social Worker Assistant as required and when involved in the patient's plan of care. The Medical Social Worker works within CenterWell Home Health's company-specific policy and procedures, applicable healthcare standards, governmental laws, and regulations. + Assesses the patient's social and emotional state as it relates to his or her illness or injury, needs for care and his or her response to such treatment, and adjustments to care. + Assesses any relationships of the patient's medical and nursing needs in the home setting, financial resources, and available community resources. + Provides any appropriate action to obtain available community resources to assist in resolving issues that may be impeding the patient's recovery. + Instructs patients and families in treating and coping with social and emotional response connected with Provides ongoing assessment of patient and family needs and responses to teaching + Assists the physician and other health team members in understanding the significant social and emotional factors related to the patient's health Participates in the development and periodic re-evaluation of the physician's Plan of Care for the patient. + Observes, records, and reports changes in patients' condition and response to treatment to the Clinical Manager and the Participates in the discharge planning process + Participates as a member of the interdisciplinary care team in care coordination activities and acts as a resource to other health team members in the identification and resolution of patient needs + Supervises instructs and evaluates the performance of the Social Work Assistant (BSW) to assure that all medical social services are provided to patients in compliance with Company, government, and professional standards + Maintains and submits documentation as required by the company and/ or facility including any case conferences, patient/physician community contacts, visit reports progress notes, and confers with other health care disciplines in providing optimum patient care. **Use your skills to make an impact** **Required Skills/Experience** + Masters or doctoral degree from a school of social work accredited by the Council on Social Work Education. + Social Worker licensure in the state of practice; if required by state law or regulation. + A valid driver's license, auto insurance, and reliable transportation are required. + Proof of current CPR certification + Minimum of one year of experience as a social worker in a health care setting, home health, and/or hospice. + Knowledge of and the ability to assist with discharge planning needs, and to obtain community resources (housing, shelter, funeral/memorial service arrangements, legal, information and referral, state/federal financial and medication programs, and eligibility. + Excellent oral and written communication and interpersonal skills. + Knowledge of medications and their correct administration. + Ability to organize tasks, develop action plans, set priorities, and function under stressful situations. + Ability to be flexible in work hours and travel locally. + Ability to communicate effectively with patients and their family members and at all levels of the organization. + Maintains current licensure certifications and meets mandatory continuing education requirements. + Must read, write and speak fluent English. + Must have good and regular attendance. + Performs other related duties as assigned. + Valid driver's license, auto insurance and reliable transportation. **Scheduled Weekly Hours** 1 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $53,700 - $72,600 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers benefits for limited term, variable schedule and per diem associates which are designed to support whole-person well-being. Among these benefits, Humana provides paid time off, 401(k) retirement savings plan, employee assistance program, business travel and accident. **About Us** About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options *************************************************************

Job Description About the Role: The PRN Home Health Social Worker plays a critical role in supporting patients and their families within the home health care setting across the United States. This position focuses on assessing psychosocial needs, providing counseling, and connecting patients to community resources to enhance their overall well-being and quality of life. The social worker collaborates closely with interdisciplinary teams, including nurses and therapists, to develop and implement individualized care plans that address both medical and social determinants of health. By offering crisis intervention, advocacy, and education, the social worker helps patients navigate complex healthcare systems and overcome barriers to care. Ultimately, this role ensures that patients receive comprehensive support that promotes independence and successful health outcomes in their home environments. Minimum Qualifications: Master's degree in Social Work (MSW) from an accredited program. Current and valid state licensure as a Licensed Clinical Social Worker (LCSW) or equivalent. Experience in home health, hospice, or community-based social work settings. Strong knowledge of psychosocial assessment techniques and care planning. Ability to work independently and manage a flexible schedule as a PRN (pro re nata) employee. Preferred Qualifications: Experience working with diverse patient populations, including elderly and chronically ill individuals. Familiarity with Medicare, Medicaid, and other healthcare reimbursement systems. Certification in hospice and palliative care social work. Experience working in home health care Proficiency in electronic medical record (EMR) systems. Bilingual skills or cultural competency training. Responsibilities: Conduct comprehensive psychosocial assessments of patients and their families to identify needs, strengths, and potential barriers to care. Develop and implement individualized care plans in collaboration with the interdisciplinary home health team. Provide counseling and emotional support to patients and caregivers, addressing issues such as coping with illness, grief, and family dynamics. Coordinate referrals to community resources, support services, and financial assistance programs to enhance patient care. Advocate for patient rights and needs within the healthcare system and community settings. Document all patient interactions, assessments, and interventions accurately and timely in compliance with regulatory standards. Participate in team meetings and communicate effectively with healthcare professionals to ensure continuity of care. Respond to crisis situations promptly, providing intervention and support as needed. Skills: The required skills enable the social worker to perform thorough psychosocial assessments and develop effective care plans tailored to each patient's unique circumstances. Strong communication and counseling skills are essential for providing emotional support and facilitating patient and family education. Organizational and documentation skills ensure compliance with healthcare regulations and accurate record-keeping. Preferred skills such as familiarity with healthcare reimbursement and EMR systems streamline coordination with interdisciplinary teams and administrative processes. Cultural competency and bilingual abilities enhance the social worker's capacity to engage with diverse populations, ensuring equitable and sensitive care delivery.

Social Services Coordinator Status: Full-Time Schedule: Monday-Friday 9a-5p Apply at Teamavamere.com The Social Services Coordinator partners with the Social Services Director to coordinate the social services program in a skilled nursing center and ensure that the residents' medically related emotional and social needs are met and maintained per all applicable laws and regulations. Essential Duties and Job Responsibilities Meets with new admissions to document the resident's psychosocial history and identify the current psychosocial needs as directed by the Social Services Director. Collaborates with the Social Services Director, leadership team, the resident and/or resident's representatives, and physician to determine discharge plans. Communicates regularly with all parties regarding the plan and encourages resident and/or resident's representative participation in all planning and discharge process steps. Coordinates home health, hospice, and support services, including making referrals and obtaining services from outside agencies as needed. Arrange ancillary services, including but not limited to dental, ophthalmology, and audiology services. Coordinating appointments for such services and transportation may be required. Completes and issues Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) as applicable. Completes assigned sections on the MDS and participates in coordinating Medicaid services. Documents care plan and services provided in the resident's record per state and federal regulatory requirements and Prestige policies. Ensures that all entries are accurate, timely, and descriptive of the services provided. Acts as a resident advocate by ensuring that services are provided in the resident's best interest and educates on residents' rights. Assists residents in accessing mental health services and other community resources. Arranges and obtains needed durable medical equipment, clothing, and personal items for residents. Conducts and assists in coordinating resident and family support groups including the development of programs for special needs residents. Manages behavioral health services, including tracking, meetings, care planning, and care and services. Coordinates and updates Behavior Monitors for residents as required. Partners with the clinical team in training staff on residents' behaviors and appropriate behavioral interventions. Attends meetings such as Stand-up, Managing Acute Care Conditions (MACC), Quality Assurance Performance Improvement (QAPI), and other meetings as required. Performs other duties as assigned. Successful incumbent employees must be able to perform the position's essential duties to the organization's satisfaction, with or without a reasonable accommodation. Requirements and Qualifications Minimum Requirements: One year of experience working in skilled nursing or similar health care setting or the ability to demonstrate equivalent knowledge and skills. Associate's degree or equivalent knowledge and skills obtained through a combination of education, training, and experience. Benefits: Health Insurance: Comprehensive medical, dental, and vision plans. Low individual and family deductible. 401 (k) Plan: After 90 days of employment, with matching program. Paid Time Off (PTO): Accrue up to 4 weeks PTO per year, 6 holidays and accrued sick leave. EAP Canopy with unlimited telehealth mental health visits. Continuing Education and Higher Education Reimbursement. Generous employee referral bonus program. Flexible Spending Accounts & CERA: Medical FSA, Dependent Care FSA and CERA (Commuter Expense Reimbursement Account). Professional Development: Opportunities for growth and development within the company. Voluntary Benefits: Life insurance, disability coverage, supplemental hospital, accident and critical illness coverage, Legal Services, Pet Insurance, discount programs and more. Avamere is an Equal Opportunity Employer and participates in E-Verify.

The Licensed Clinical Social Worker (LCSW) independently provides comprehensive biopsychosocial/spiritual assessment, diagnosis and/or treatment/interventions/advocacy of patients and their support systems. The LCSW incorporates concepts and theories associated with life span development, neurobiology, and behavioral change. The LCSW will collaborate with the patient and support system to develop and implement evidence-informed person-centered care plans across the care continuum in collaboration with the Inter/Multi-Disciplinary Team (IDT). The LCSW shall perform duties in a manner that respects patient self-determination, that reduces health disparities/barriers to care, and adheres to the NASW code of ethics, Standards of Practice (SOP), and mission. Providence caregivers are not simply valued - they're invaluable. Join our team at Oregon Clinical Programs and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them. Required qualifications: + Master's Degree in Social Work from a CSWE Accredited School of Social Work, OR from a school in candidacy status by the council of Social Work Education (CSWE). + Upon hire: Oregon Clinical Social Worker License. Or + Upon hire: Social Worker License in state(s) of hire, and wherever care is delivered. + 2 years of relevant Social Work experience. May include CSWA experience. Preferred qualifications: + 1 year Experience in acute care settings. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. About the Team Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers. PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St. John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico. Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Requsition ID: 408791 Company: Providence Jobs Job Category: Social Services Job Function: Clinical Care Job Schedule: Part time Job Shift: Day Career Track: Clinical Professional Department: 5013 PMG CP N BH EAST OP Address: OR Portland 4805 NE Glisan St Work Location: Providence Portland Medical Ctr-Portland Workplace Type: Hybrid Pay Range: $39.73 - $61.68 The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.